Left anterior descending coronary artery dissection after blunt chest trauma: Assessment by multi-detector row computed tomography

Abstract

Clinical Summary Two months earlier, this unrestrained driver had an accident and sustained steering wheel injury as well as head trauma and multiple fractures. He was admitted to the intensive care unit for loss of consciousness at the scene and had his fractures repaired. Follow-up was unremarkable and he was discharged 1 month after the accident. A few days later, he presented with chest pain associated with ST elevation in the precordial leads on electrocardiogram and high serum level of creatine kinase with a positive MB fraction. Transthoracic echocardiography showed moderate hypokinesis of the septum and the anterior wall. MDCT coronary angiography was carried out using a 64-slice LightSpeed VCT (General Electric Healthcare, Little Chalfont, UK) with 0.625-mm collimation, cardiac gating, and intravenous injection of iopromide 370 mg (milligrams of iodine)/mL (Ultravist, Schering AG, Germany). It showed septoapical and anteroseptal subendocardial linear hypodensity (Figure 1) associated with hypokinesis on cine mode, corresponding to infarcted area of the myocardium. Left ventricle ejection fraction was 43%. Coronary artery analysis showed a left dominant distribution with arterial dissection beginning at the ostium of the left anterior descending coronary artery (LAD) and extending 10 mm distally with a dilated false lumen giving rise to a septal artery and slightly narrowing the true lumen (Figure 2). The patient had a coronary artery bypass, using the left internal thoracic artery to LAD. A year later, he is doing well and living a normal active life.