Simultaneous dissection and intramural hematoma of left anterior descending and circumflex coronary arteries after blunt chest trauma

Abstract

Non-penetrating chest trauma can cause acute myocardial infarction. Autopsy and clinical studies showed that the incidence of coronary artery dissections secondary to chest trauma is rather low. In this case, we described simultaneous dissection of both left anterior descending (LAD) and circumflex (LCX) coronary arteries due to chest trauma that was successfully corrected by drug-eluting stent implantation. A 43-year-old healthy man previously healthy with no major risk factors for coronary artery disease suffered blunt chest trauma when he was involved in a motorbike accident. He did not lose consciousness in the accident. The patient was placed in full spinal immobilization at the scene, and transferred by ground ambulance to our hospital. On arrival, he was in moderate distress, talking without stridor, alert and oriented and complaining of ongoing 8/10 retrosternal chest pain. His trachea was midline, and he was not using accessory muscles of respiration. His vitals were as follows: pulse 110 beats/min, blood pressure 110/60 mm Hg, respiratory rate 20 per minute and oxygen saturation 94% on room air. Chest exam revealed bruising and skin laceration on the anterior chest with moderate tenderness upon palpation. Breath sounds were equal and normal. Cardiac auscultation was normal with no murmurs. Her abdomen, pelvis, and long bones were unremarkable. Her peripheral pulses were palpable and symmetrical. Chest X-ray was also unremarkable.