Blunt cardiac injury presenting as a left-sided coronary artery dissection

Abstract

The presentation of blunt cardiac injuries (BCIs) following thoracic trauma is extremely varied, classically affecting the right-sided chambers of the heart. In extremely rare cases, BCIs can affect the coronary arteries. Diagnosing a traumatic coronary dissection can be challenging, as not only is presentation highly variable, but dissections are often masked by concomitant injuries. Here, we present the unusual case of a patient presenting to the emergency department following blunt thoracic trauma from an automobile accident. He demonstrated diffuse S and T wave segment elevations on electrocardiogram, and coronary angiography was significant for occlusion of the apical left anterior descending artery and stenosis of the second obtuse marginal artery. The patient was diagnosed with a BCI causing a left-sided coronary artery dissection. This serves as an important reminder that BCIs can manifest in any part of the cardiac anatomy, and should be considered in any patient with a history of thoracic trauma.

Figure 1

Chest X-Ray and CT imaging showing rib fracture. (A) Chest X-ray and (B) CT showing fractures to the left ribs.

Figure 2

Initial ECG showing ST Elevation anterolateral injury pattern.

Figure 3

Coronary angiography showing occlusion of the apical left anterior descending artery and stenosis of the second obtuse marginal artery.