Beware of False-Negative FAST Exams in Precordial Penetrating Trauma

Intrapericardial blood might empty into the hemithorax and cause false-negative pericardial views.

Focused assessment with sonography for trauma (FAST) includes a pericardial view, which has been shown in numerous large studies to have high sensitivity and specificity for detecting hemopericardium. These authors describe cases of false-negative pericardial views in patients with penetrating wounds to the heart. In a retrospective review of the trauma registry at a single level I trauma center between 2005 and 2008, the authors identified 228 patients with penetrating wounds to the precordium who underwent FAST examinations. Overall, 37 FAST examinations were positive, and 5 were false negative.

All five patients with false-negative FAST exams had penetration of the left hemithorax with concomitant left hemothoraces that required thoracost…

Reviewing Author

John A. Marx, MD, FAAEM