Post Traumatic Pseudoaneurysm of Left Anterior Descending Artery Presenting as Acute Coronary Syndrome

Abstract

Penetrating cardiac injuries are highly lethal and carry high mortality rate. Both blunt and penetrating cardiac injuries in patients who survive are known to present with well-known sequelae that often appear days to weeks after the initial insult. In the literature there have been documented cases of cardiac injury induced myocardial infarction, ventricular aneurysms, valvular dysfunction and even fistulous tracts between the coronary vessels and chamber. Although the most commonly injured vessel is the left anterior descending (LAD) coronary artery, traumatic injuries to the left coronary artery result in early death in the majority of cases. We present a unique case of LAD pseudo aneurysm and stenosis presenting as acute coronary syndrome (ACS) months after the initial penetrating cardiac injury successfully managed by stenting. There are only few isolated case reports of coronary artery pseudoaneurysm following penetrating chest trauma published in English literature.

Keywords: Acute coronary syndrome; Cardiac trauma; Left anterior descending artery; Post traumatic pseudoaneurysm.

Figure 1

Initial presenting chest X-ray following chest tube insertion.

Figure 2

CT scan on initial admission demonstrating left-sided subcutaneous air and small residual pneumothorax with chest tube in place.

Figure 3

Initial EKG on first admission.

Figure 4

EKG at second admission demonstrating ST elevation.

Figure 5

Initial cardiac catheterization.

Figure 6

Intravascular USG showing pseudoaneurysm.

Figure 7

(a) Coronary angiography showing stenosis. (b) Balloon angioplasty. (c) No stenosis present in the previously balloon angioplasty and stented segment.

Figure 8

Left coronary angiography 3 days after the second intervention showing no restenosis.