Commotio cordis: Insights from a case of blunt chest trauma and a road map for the correct diagnosis

Abstract

Commotio cordis (CC) is a rare cause of sudden cardiac death resulting from a blunt, non-penetrating impact to the precordium, in the absence of underlying cardiac pathology or structural damage. Although most frequently described in adolescents engaged in sports activities, CC may also occur in non-sport contexts. We report the case of a 43-year-old male construction worker who died after being struck in the chest by a slow-moving truck. Postmortem computed tomography (PMCT) revealed multiple left rib fractures, costal cartilage fractures, manubriosternal dislocation and pulmonary contusions. Conventional autopsy confirmed the absence of cardiac rupture, coronary disease or pericardial injuries. Histological analysis supported a diagnosis of electromechanical dissociation by fatal arrhythmia.

In our review of six previously published articles involving similar cases, autopsy was the principal diagnostic tool in all instances. PMCT was employed in only one case, prompted by circumstantial suspicion of child abuse.

This case underscores the importance of a multidisciplinary forensic approach, combining PMCT and traditional autopsy to reconstruct the traumatic event and rule out other mechanisms of death. CC remains a diagnosis of exclusion, requiring demonstration of precordial impact, absence of lethal structural injuries, and lack of alternative causes of death on autopsy and toxicological examination.

PMCT should be strongly recommended in cases of sudden death following blunt thoracic trauma, even when external signs are minimal or absent.