CASE REPORT
Myocardial Contusion Boxing Match
After a Professional
Paolo Bellotti, MD, Francesco Chiarella, MD, Stefano Domenicucci, MD, Gabriele Lupi, MD, and Carlo Vecchio, MD ost casesof cardiac contusion due to blunt chest trauma are M frequently seen after motor vehicle accidents, and only rarely during sport practice. Therefore, there are only few reports of such injuries occurring during competitive sport activities.td3 We describe the first case of cardiac trauma occasionally observedin a professionalboxer after a world championship boxing match. A 32-year-old professional boxer was referred to our hospital with a diagnosis of traumatic detachment of the retina 2 days after a world medium-maximum weight championship boxing match. He was asymptomatic and the only remarkable data concerning the physical examination was multiple ecchymotic injuries to the face. During hospitalization, while waiting for possible surgical reparation of the retina detachment, he underwent routine chest-x-ray, electrocardiogram and serum blood exams. The electrocardiogram, in absenceof symptoms, showed unexpectedabnormalities in the precordial leads, with a negative T wave in VI and a 2 to 4 mm STsegment elevation in Vz-V3 (Figure IA). To assessthe evolution of the myocardial injury, serial electrocardiography and 2-dimensional echocardiography, and 1 radionuclide angiography at rest wereperformed. The electrocardiographic abnormalities returned to normal during 1 month (Figure 1B). Two-dimensional echocardiograms did not reveal any change in myocardial brightness, ventricular wall motion, pericardial thickening or effusion. Technetium pyrophosphate radionuclide angiography was normal with homogeneouscardiac uptake distribution. Cardiac enzymes revealed a slight increase in total creatinine From Divisione di Cardiologia, E. 0. Ospedali Galliera, Via Volta 8, 16128 Genova, Italy. Manuscript receivedAugust 26,199 1; revised manuscript received and accepted October 7, 1991.
phosphokinase and MB fraction with peaks of 297 and 39 nV/liter, respectively, (creatinine phosphokinasenormal laboratory range, lO% of the total creatinine phosphokinase,wasfound in absence of symptoms, but it must be taken into account that the enzymatic determination could be influenced, as well as chest pain coveredby multiple traumatic boxing punches. A coronary arteriography would have been useful for excluding a primary coronary disease,but it was not proposed for the young age of our patient. Pandian et ak4 in an experimental setting, reported that 2-dimensional echocardiography can be used for identifying heart contusion
710
after blunt chest trauma, but a low- of recognizingthis problem with serienergy trauma may produce only al electrocardiograms. minimal pathologic changes that may be undetectableon echocardiogRothstein RJ. Myocardial contusion. JAMA raphy. Chest trauma by hands cov- 1. 1983;250:2189-2191. eredwith boxing glovesis certainly of 2. Helling TS, Duke P, BeggsCWr Grouse LJ. A relative low intensity; this can ex- prospectiveevaluation of 68 patients suffering blunt chesttrauma for evidenceof cardiac injury. J Trauplain why, in our patient, no abnor- ma 1989;29:961-966. malities were detected on serial 2- 3. Watt A, StephensM. Myocardial infarction after blunt chest trauma incurred during rugby football dimensionalechocardiogramsand on later required cardiac transplantation. Br Hearf J the radionuclide scan. 1986;55:408-410. Nonpenetrating cheattrauma has 4. Pandian NA, Skorton DJ, Doty DB, Kerber RE. diagnosisof acute myocardial contusion become increasingly common, but Immediate by two-dimensional echocardiography:studies in a we are not aware of any other report caninemodelof blunt chesttrauma. J Am CON Carof myocardial contusion after a pro- dial 1983;2:488-496. 5. Dolara A, Morando P, PampaloniM. Electrocarfessional boxing match. It is not diographic findings in 98 consecutivenon-penetring known if this complication is com- chest injuries. Chest 1967;52:50-56. mon during boxing practice, but be- 6. Potkin R, Werner J, Trobaugh G, Chestnut C, C, Hallstrom A, Cobb L. Evaluation of noncause of the lethal potential of this Carrico invasive test of cardiac damagein suspectedcardiac injury, we emphasizethe importance contusion. Circulation 1982;3:627-631.
THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 69
MARCH 1, 1992
Myocardial Contusion Boxing Match
After a Professional
Paolo Bellotti, MD, Francesco Chiarella, MD, Stefano Domenicucci, MD, Gabriele Lupi, MD, and Carlo Vecchio, MD ost casesof cardiac contusion due to blunt chest trauma are M frequently seen after motor vehicle accidents, and only rarely during sport practice. Therefore, there are only few reports of such injuries occurring during competitive sport activities.td3 We describe the first case of cardiac trauma occasionally observedin a professionalboxer after a world championship boxing match. A 32-year-old professional boxer was referred to our hospital with a diagnosis of traumatic detachment of the retina 2 days after a world medium-maximum weight championship boxing match. He was asymptomatic and the only remarkable data concerning the physical examination was multiple ecchymotic injuries to the face. During hospitalization, while waiting for possible surgical reparation of the retina detachment, he underwent routine chest-x-ray, electrocardiogram and serum blood exams. The electrocardiogram, in absenceof symptoms, showed unexpectedabnormalities in the precordial leads, with a negative T wave in VI and a 2 to 4 mm STsegment elevation in Vz-V3 (Figure IA). To assessthe evolution of the myocardial injury, serial electrocardiography and 2-dimensional echocardiography, and 1 radionuclide angiography at rest wereperformed. The electrocardiographic abnormalities returned to normal during 1 month (Figure 1B). Two-dimensional echocardiograms did not reveal any change in myocardial brightness, ventricular wall motion, pericardial thickening or effusion. Technetium pyrophosphate radionuclide angiography was normal with homogeneouscardiac uptake distribution. Cardiac enzymes revealed a slight increase in total creatinine From Divisione di Cardiologia, E. 0. Ospedali Galliera, Via Volta 8, 16128 Genova, Italy. Manuscript receivedAugust 26,199 1; revised manuscript received and accepted October 7, 1991.
phosphokinase and MB fraction with peaks of 297 and 39 nV/liter, respectively, (creatinine phosphokinasenormal laboratory range, lO% of the total creatinine phosphokinase,wasfound in absence of symptoms, but it must be taken into account that the enzymatic determination could be influenced, as well as chest pain coveredby multiple traumatic boxing punches. A coronary arteriography would have been useful for excluding a primary coronary disease,but it was not proposed for the young age of our patient. Pandian et ak4 in an experimental setting, reported that 2-dimensional echocardiography can be used for identifying heart contusion
710
after blunt chest trauma, but a low- of recognizingthis problem with serienergy trauma may produce only al electrocardiograms. minimal pathologic changes that may be undetectableon echocardiogRothstein RJ. Myocardial contusion. JAMA raphy. Chest trauma by hands cov- 1. 1983;250:2189-2191. eredwith boxing glovesis certainly of 2. Helling TS, Duke P, BeggsCWr Grouse LJ. A relative low intensity; this can ex- prospectiveevaluation of 68 patients suffering blunt chesttrauma for evidenceof cardiac injury. J Trauplain why, in our patient, no abnor- ma 1989;29:961-966. malities were detected on serial 2- 3. Watt A, StephensM. Myocardial infarction after blunt chest trauma incurred during rugby football dimensionalechocardiogramsand on later required cardiac transplantation. Br Hearf J the radionuclide scan. 1986;55:408-410. Nonpenetrating cheattrauma has 4. Pandian NA, Skorton DJ, Doty DB, Kerber RE. diagnosisof acute myocardial contusion become increasingly common, but Immediate by two-dimensional echocardiography:studies in a we are not aware of any other report caninemodelof blunt chesttrauma. J Am CON Carof myocardial contusion after a pro- dial 1983;2:488-496. 5. Dolara A, Morando P, PampaloniM. Electrocarfessional boxing match. It is not diographic findings in 98 consecutivenon-penetring known if this complication is com- chest injuries. Chest 1967;52:50-56. mon during boxing practice, but be- 6. Potkin R, Werner J, Trobaugh G, Chestnut C, C, Hallstrom A, Cobb L. Evaluation of noncause of the lethal potential of this Carrico invasive test of cardiac damagein suspectedcardiac injury, we emphasizethe importance contusion. Circulation 1982;3:627-631.
THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 69
MARCH 1, 1992
