Traumatic coronary artery dissection: a case report and literature review.
BACKGROUND
Coronary artery dissection after blunt chest trauma is a rare, life-threatening condition.


OBJECTIVE
To present a case of coronary artery dissection after blunt chest trauma and to outline the appropriate management of this condition based on a literature review.


METHODS
We report the case of a 50-year-old woman with traumatic coronary artery dissection after a high-speed motor vehicle collision. She presented to the Emergency Department via ambulance within a few hours of the collision, and her clinical condition deteriorated rapidly. A 12-lead electrocardiogram on arrival demonstrated anterolateral ST-segment elevation. The patient was intubated due to hypoxemic respiratory failure and she required inotropes for blood pressure support. Computed tomography imaging revealed pulmonary edema and right third and fourth rib fractures. Emergent angiography demonstrated dissection of her left main coronary artery, requiring placement of a stent.


CONCLUSIONS
Early recognition of this clinical entity with a screening electrocardiogram, and aggressive management, may result in a favorable outcome. A literature review reveals that coronary artery bypass grafting, angiography with stent placement, and conservative management may all be considered viable treatment options for this condition.
Lobay
Kevin W
KW
Department of Emergency Medicine, University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
MacGougan
Cameron K
CK
D000063:Accidents, Traffic; D000792:Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D015607:Stents; D014652:Vascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000150:complications*