Penetrating cardiac injury with no initial radiological findings and negative E-FAST: The critical role of clinical judgment

We report the case of a man in his forties admitted to hospital after being stabbed in the precordial region. The initial chest X-ray and FAST examination revealed nothing abnormal. Despite apparent haemodynamic stability, the patient developed progressive dyspnoea, diaphoresis and signs of circulatory compromise. Due to clinical deterioration, an emergency exploratory thoracotomy was performed. Intraoperative findings revealed haemothorax, haemopericardium, and a perforation of the right atrium associated with pericardial rupture. The cardiac injury was successfully repaired, and the patient recovered favourably. This case demonstrates that initial negative imaging does not rule out significant cardiac injuries in penetrating chest trauma. Careful clinical reassessment and timely surgical intervention remain critical for patient survival.