Traumatic Coronary Artery Dissection: A Case Report and Literature Review

Lobay, K.; MacGougan, Cameron K.

doi:10.1016/j.jemermed.2010.04.019

Cited by 48 publications

(47 citation statements)

References 24 publications

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“…Trauma associated with road traffic collision is the most common situation resulting in coronary artery injury, followed by sporting accident, attack by an animal, and assault during a fight [2,16]. In an older report, coronary artery rupture was not an uncommon condition after non-penetrating trauma to the heart (10/546 cases) [7], but there have been few reports in the past decade of obvious coronary artery rupture [8][9][10]12], and dissection seems to be the most common finding [2,4,15,17,18]. The mechanism of traumatic coronary artery dissection is hypothesized to be shearing stress during a traumatic episode, which causes intimal tear of the vulnerable part and subsequently initiates the process of thrombus formation.…”

Section: Discussionmentioning

confidence: 99%

“…However, differentiating between a slight thoracic contusion and a significant cardiac injury is a challenge for any physician attempting to make an early diagnosis of traumatic heart injury [4,15,17]. With the functional advancement of multi-detector CT, enhanced CT can now be easily performed for diagnostic screening after trauma [22,23], and some reports have described the usefulness of cardiac CT in the early diagnosis of coronary artery injury in patients with chest pain after trauma [24,25].…”

Section: Discussionmentioning

confidence: 99%

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Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography

et al. 2015

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Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography

et al. 2015

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“…Eight patients were treated with CABG, 7 were treated with stent placement, and 9 were treated conservatively. 8 This literature review shows that CABG, angiography with stent placement, and conservative management can all be considered viable treatment options for this condition.…”

Section: A B a Bmentioning

confidence: 99%

Left Internal Thoracic Artery Graft to Left Anterior Descending Coronary Artery after Blunt-Chest-Trauma Myocardial Infarction: 14-Year Outcome

Évora¹,

Romano²,

Souza³

et al. 2017

Texas Heart Institute Journal

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“…9 A case series that reviewed 24 patients revealed that 8 patients were treated with coronary artery bypass grafting, 7 were treated with stent placement, and 9 were treated conservatively. 17 Given that the mechanism of coronary artery occlusion in coronary artery dissection is not thrombosis, it is perhaps prudent to avoid thrombolytics and glycoprotein IIb/IIIa antagonists. There exists the theoretical risk of propagation of the dissection with these agents.…”

Section: What Might Lead To a Missed Diagnosis Of This Condition?mentioning

confidence: 99%

Cardio-embolic stroke following remote blunt chest trauma

Arora

Atreya

Penumetsa

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tA cardio-embolic stroke as a sequela of remote blunt chest trauma is a rare clinical presentation. Blunt chest trauma can cause various acute cardiac complications like arrhythmias, cardiac contusion etc. However, delayed consequences such as left ventricular thrombus resulting in thromboembolic phenomena are reported infrequently.A 30-year-old healthy man presented to an outside facility with transient neurological deficits. An MRI brain showed lesions suggestive of embolic etiology. A trans-thoracic echocardiogram (TTE) showed a 1.5 Â 1.5 cm mass present in the left ventricular (LV) apex. Patient was transferred to our institution for cardiac surgery evaluation. On detailed questioning, he reported an incident of blunt chest trauma during a martial arts exhibition fight that took place 2 years back. Given this history, a cardiac catheterization was done, which showed 30% stenosis in mid-left anterior descending artery (LAD) without any other significant obstructive lesion. A trans-esophageal echocardiogram (TEE) showed akinesis of the LV apex and confirmed TTE finding of a mass, consistent with an apical thrombus. Surgery was deferred and patient was started on anticoagulation. A cardiac MRI done 2 weeks later showed evidence of apical infarction in the LAD territory.LAD is the most commonly affected coronary vessel by blunt traumatic injuries, likely due to its vulnerable anatomical position on the anterior aspect of the heart. A variety of mechanisms including intimal tear, rupture and spasm have been implicated in the pathogenesis of myocardial infarction after blunt chest trauma.

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Traumatic Coronary Artery Dissection: A Case Report and Literature Review

Cited by 48 publications

References 24 publications

Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography

Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography

Left Internal Thoracic Artery Graft to Left Anterior Descending Coronary Artery after Blunt-Chest-Trauma Myocardial Infarction: 14-Year Outcome

Cardio-embolic stroke following remote blunt chest trauma

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