THE DIAGNOSTIC VALUE OF AIR IN THE ANTERIOR PERICARDIAL LIGAMENTS IN
PENETRATING MINE-EXPLOSIVE WOUNDS OF THE CHEST CAVITY
Akhiyev M.I.1,2, Kitayev V.M.1,3, Abnizov A.S.1, Badurov B.SH.1, Komogorova A.A.1
1- A.A. Vishnevsky National Medical Research Center of High Medical Technologies. Krasnogorsk, Russia.
2-Branch of the S.M. Kirov Military Medical Academy of the Russian Ministry of Defense. Moscow, Russia.
3- Central State Medical Academy. Department of Radiology and Ultrasound Diagnostics. Moscow, Russia.
To substantiate the presence of isolated air collection in the anterior pericardial ligaments as a sign of rupture and pericardial contusion.
Materials and methods. A retrospective analysis of CT scans was performed in 97 wounded patients with diagnosed pericardial contusion and 117 wounded patients without contusion. Inclusion criteria included the presence of penetrating mine-explosive wounds of the chest cavity and a CT scan performed no later than five days after injury. Exclusion criteria included abdominal surgery performed during previous stages of medical evacuation. In all selected cases, CT scans were performed on the day of admission and were performed in the standard "chest cavity" mode. The image reconstruction thickness was 1.5 mm. A repeat analysis of the electronic CT scan records examined the distribution and quantity of air in the mediastinal regions. To quantify the air collection, the concepts of minimal, small, and large volume were introduced.
Results and discussion. It was established that air was present in the mediastinum in 69 cases with pericardial contusions, and in 30 cases without contusion (P = 0.042). In cases without contusion, on the contrary, there was a significant excess of absence of air – 88 versus 27 (P = 0.037). In cases of isolated air accumulation only in the anterior mediastinum and pericardial ligaments, the ratio of the number of observations with air accumulations in pericardial contusion exceeded observations without contusion by more than five times, as 33:6 (P = 0.014). Moreover, large-volume accumulations corresponded to contusion in 14 observations, and in the absence of contusion, cases of large air accumulation were not detected (P ˂ 0.05). Minimal and small air accumulations in contusions were detected in 11 cases versus 2 without contusion (P = 0.019). When air accumulated in the middle and posterior mediastinum, no air was detected in the anterior mediastinal space; the ratio of cases with and without contusion was virtually identical, 5:6. Air accumulation in the pericardial ligaments and in all sections of the mediastinum, both in presence and volume, also showed no significant difference between cases with and without contusion. Thus, a significant predominance of air localization in cases of contusion was observed only with the first distribution pattern, indicating air migration along the following pathway: pleural cavity, anterior pericardial ligaments, indicating their rupture, and the anterior mediastinal space.
Conclusion. Comparison of the presence and volume of air in the pericardial ligaments confirms that direct air entry from the pleural cavity is a consequence of the ligament rupture. Therefore, air within the anterior mediastinum area and pericardial ligaments, in the absence of air in other areas of the mediastinum, indirectly indicates on pericardial contusion.
Keywords: pericardial contusion, rupture of the anterior pericardial ligaments, pneumomediastinum, mediastinal wounds.
Corresponding author: Abnizov A.S., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Akhiyev M.I., Kitayev V.M., Abnizov A.S., Badurov B.SH., Komogorova A.A. The diagnostic value of air in the anterior pericardial ligaments in penetrating mine-explosive wounds of the chest cavity. REJR 2026; 16(1):42-51. DOI: 10.21569/2222-7415-2026-16-1-42-51.
Received: 31.03.26 Accepted: 06.05.26