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Case Reports
. 2016 Apr 7:2016:bcr2016214424.
doi: 10.1136/bcr-2016-214424.

Spontaneous coronary artery rupture without a pericardial effusion: a diagnostic challenge

Utkan Sevuk  1 , Sertan Ozyalcin  2 , Firat Ayaz  2 , Kaan Kose  2
Affiliations
Case Reports

Spontaneous coronary artery rupture without a pericardial effusion: a diagnostic challenge

Utkan Sevuk et al. BMJ Case Rep. .

Abstract

Spontaneous coronary artery rupture (CAR) is an extremely rare, life-threatening entity. It is a challenge to make a diagnosis of CAR in the absence of pericardial effusion. We describe a case of a spontaneous rupture of the right coronary artery (RCA) without pericardial effusion that emphasises the benefit of high clinical suspicion and early diagnosis. A 60-year-old man was admitted to the emergency department, with inferior myocardial infarction. Echocardiogram was negative for a pericardial effusion. Coronary angiography revealed complete occlusion of the RCA with intraluminal dissection and extravasation of contrast into the epicardium at the mid-portion of the RCA, which suggested rupture of the RCA. The patient underwent uneventful emergency coronary artery bypass grafting. CAR should be considered as a differential diagnosis in patients with acute chest pain, even in the absence of pericardial effusion, particularly in case of inferior wall involvement.

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Figures

Figure 1
Figure 1
(A) Coronary angiogram image showing the stenosis of the left anterior descending artery (white arrow). (B) Coronary angiogram image showing right coronary artery (black arrow) with intraluminal dissection and extravasation of contrast into the epicardium (white arrow).
Figure 2
Figure 2
Intraoperative image showing a subepicardial haematoma in the right ventricle (black arrow).
See this image and copyright information in PMC

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