Your major trauma patient presents with jugular vein distention while sitting up. Which of the following conditions may be the cause?

• A. Pericardial tamponade
• B. Massive hemothorax
• C. Flail chest
• D. Diaphragmatic hernia

Answer: (A)

Jugular venous distention in a trauma patient who is sitting up signals increased central venous pressure from impaired cardiac filling, most classically caused by cardiac tamponade. When blood leaks into or around the pericardium, the accumulating fluid raises pericardial pressure and restricts diastolic filling of the heart. The ventricles can’t fill effectively, so blood backs up into the venous system, making the neck veins appear distended. This effect is often more noticeable when upright because gravity aids venous pooling.

Massive hemothorax also reduces preload by losing blood into the chest, but its hallmark is shock with decreased breath sounds and dullness to percussion on the affected side rather than a prominent JVD. Flail chest produces chest wall instability and significant respiratory effort but not characteristic JVD. A diaphragmatic hernia disrupts diaphragmatic function and lung mechanics, and JVD is not a defining feature.