Dissection of the left main coronary artery after blunt thoracic trauma: Case report and literature review

Abstract

Blunt chest trauma is commonly encountered by surgeons and is rarely associated with cardiac injuries. The incidence of cardiac injury is rare but can be rapidly fatal, requiring prompt recognition and treatment. We review the case of a 37 year-old male who was involved in a head-on motor vehicle collision at highway speed and was found to have an isolated left main coronary artery dissection. We then review the supporting literature for evaluation of blunt cardiac injuries and the treatment options for traumatic coronary dissection.

Figure 1

The chest radiograph taken in the trauma bay does not demonstrate acute intrathoracic injury.

Figure 2

The EKG demonstrates ST segment elevation in leads I, III, aVL, and aVF, as well as precordial leads V2-V5. This suggests anterior wall ischemia and the patient underwent emergent coronary angiography.

Figure 3

The angiogram demonstrates a 50% diffuse stenosis of distal left main artery with left main dissection. The LAD had 95% occlusion and 50% stenosis of the circumflex arteries. An intra-aortic balloon pump was placed and the patient was taken emergently to the operating room for coronary bypass.