Rationale: Traumatic cardiac rupture with concurrent cerebral herniation represents a critical emergency characterized by an extremely high prehospital mortality rate. Early diagnosis and multidisciplinary intervention are essential for survival. As this is a single-case report, the observations should be interpreted with caution. Patient concerns: A 45-year-old woman presented in a coma with hemorrhagic shock following a traffic accident. Imaging revealed a massive left hemothorax, multiple rib fractures, and a right subdural hematoma with a 10 mm midline shift. Diagnosis: Emergency surgery confirmed the diagnoses of cardiac rupture and cerebral herniation. Interventions: Damage-control surgery was initiated within 2 hours and included emergency thoracotomy for cardiac repair and decompressive craniectomy. Outcome: The patient was discharged on postoperative day 54. During follow-up, she exhibited no delayed cardiac complications on echocardiography. Lessons: This case is notable for the rare concurrence of traumatic cardiac rupture and evolving cerebral herniation, necessitating staged, back-to-back thoracotomy and decompressive craniectomy. Early recognition, multidisciplinary coordination, and adherence to damage-control sequencing were essential for survival.
Zhu et al. (2026) studied this question.