Abstract
BackgroundBlunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy.Case presentationHere we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting.ConclusionPerfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.
Highlights
Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction
Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and coronary artery injury leading to myocardial ischemia or infarction
According to a review of 77 published cases of myocardial infarctions caused by blunt chest trauma (BCT), the most frequently injured vessel is left anterior descending artery (LAD) (71%), followed by right coronary artery (19%), left main artery (6%), and left circumflex artery (3%)
Summary
AMI due to coronary artery dissection after BCT is rare and may be life threatening. Perfusion defects of myocardium enhancement on CT can be very helpful to suggest myocardial infarction and facilitate the decision. Limitation Coronary optical coherence tomography and intravascular ultrasound can provide further informative assessment of the dissected coronary artery, and facilitated the selection of size and length of the stent. In this case, we did not perform these procedures due to the unstable hemodynamic condition and no insurance coverage of the procedures
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