[Pulmonary embolism as a late complication of heart contusion].

A 57 year-old woman was hospitalized because of a sternal fracture inflicted during a car accident. During the following two weeks she became breathless and was readmitted after having syncope, induced by exertion. A perfusion scan of the lungs showed pulmonary emboli in both the lower lobes. After anti-coagulation treatment her symptoms faded, but the ultrasonographic signs of pulmonary hypertension persisted for nearly four months. The probable mechanism behind the pulmonary embolism was transmural contusion of the right ventricle, leading to a mural thrombus which eventually became detached. The authors review the literature and discuss problems connected to the diagnostic criteria for cardiac contusion, as well as delayed complications, of which pulmonary embolism is a potentially lethal condition.