Traumatic disruption of the brachiocephalic artery

We report the case of a patient presenting with blunt chest and head injuries. Initial emergency department evaluation revealed a pulmonary contusion and suspected closed head injuries. Computed tomographic scan of the head was unremarkable. An angiogram performed to further investigate the nature of his head injuries revealed a disruption of the brachiocephalic artery. The lesion was surgically repaired in the operating room and the patient was moved to the intensive care unit, where he remained comatose and died from complications of his head and chest injuries on the seventh post-operative day. The pathophysiology and clinical manifestations of injuries to the brachiocephalic artery are discussed.     

Chest pain in the emergency room—an interesting case presentation

A 61‐year‐old woman presented to the emergency room with atypical chest pain, non‐diagnostic electrocardiogram, and an initial troponin level that was normal. A coronary computed tomography angio (CCTA) was performed, and on initial review, it appeared to be normal. Subsequent review including evaluation of functional data from the retrospective scan identified a distal left anterior descending occlusion and an apical wall‐motion abnormality with no other evidence of heart disease. This case illustrates the complementary contribution of anatomic and functional data and serves to remind us that on rare occasions, what looks “normal” is not always normal.     

Blunt Chest Trauma Resulting in Both Atrial and Ventricular Septal Defects

Cardiac septal defects are known complications to blunt chest trauma. The incidence of a traumatic isolated atrial septal defect is unknown and the concurrent occurrence of nonlethal ventricular and atrial septal defects has not been reported. A healthy male sustained violent blunt chest trauma resulting in traumatic cardiac septal disruption in the atrium and ventricle. The defects were detected by echocardiography within 14 hours of the accident. The extent of damage was confirmed at the time of surgical repair. The patient recovered uneventfully. The diagnosis and management of concurrent ASD and VSD is similar to single septal injury.     

Hemoptysis following blunt trauma: case report

A 9-year-old boy developed significant hemoptysis and pulmonary parenchymal injury following blunt trauma. There was delayed development of hemoptysis following chest injury, and the trauma did not produce any evidence of external body injury.     

Traumatic thrombosis of the left main coronary artery and myocardial infarction caused by blunt chest trauma

We report the case of a 38-year-old man who, after a blunt chest trauma, developed an acute transmural myocardial infarction. Coronary arteriography revealed a thrombus in the left main artery, occlusion of the distal left anterior descending artery, and a diagonal branch caused by emboli.     

Complete Heart Block Following a Blow on the Chest by a Soccer Ball: A Rare Manifestation of Commotio Cordis

Commotio cordis is a rare type of blunt cardiac injury in which low impact chest trauma causes sudden cardiac arrest, usually occurs from being struck by a projectile during sports. The most common arrhythmia during commotio cordis is ventricular fibrillation, although complete heart block and an idioventricular rhythm have also been reported. We describe a case of a young patient who presented with a persistent third‐degree atrioventricular block and a left bundle branch block, following blunt chest trauma, as a result of blow by soccer ball and subsequently needed a permanent pacemaker.     

Severe Mitral Regurgitation Caused by Perivalvular Abnormal Communication of the Mitral Valve Due to Blunt Chest Trauma

Perivalvular leaks are usually caused by suture interruption in prosthetic valves or infective endocarditis. Traumatic mitral annular dehiscence is a very uncommon event. We present a rare case of severe mitral regurgitation secondary to perivalvular abnormal communication in a 35‐year‐old man with a history of blunt chest trauma. He presented with symptoms of cough and chest tightness for 3 months. Preoperative two‐dimensional and real time three‐dimensional transesophageal echocardiography clearly showed the position and size of the perivalvular abnormal communication and the incident damage of the left ventricular wall. The patient finally underwent successful surgical repair.     

Spontaneous coronary artery dissection in young women

Spontaneous dissection of the coronary arteries is quite rare. It is usually a catastrophic event with fatal outcome. We report two interesting cases of spontaneous dissection whose presentations exemplify the variable course the disorder may take. The first is the only report to our knowledge associated with aerobic exercise; the second is the only reported attempt at treatment with intracoronary thrombolysis. © 1996 Wiley-Liss, Inc.     

Myocardial contusion presented as acute myocardial infarction after chest trauma

A 46-year-old male patient developed an acute myocardial infarction and congestive heart failure following blunt chest trauma. Electrocardiogram (ECG) revealed acute anterior myocardial infarction. Echocardiography showed akinesis of interventricular septum, dyskinesis in apical anterior wall, and severe impairment of left ventricular overall systolic function. Coronary angiography revealed normal coronary arteries. The patient followed a low-intensity physical medicine rehabilitation program. Follow-up was without new complications or deterioration of congestive heart failure. Five months later the patient presented with fulminant acute pulmonary edema and cardiogenic shock. Cardiopulmonary resuscitation was unsuccessful.     

The risk of percutaneous chest tube thoracostomy for blunt thoracic trauma

Analysis of 164 percutaneous chest tube thoracostomies performed as a standardized technical procedure in the management of 129 blunt trauma victims demonstrated an overall complication rate of 9.1% (15 of 164). Three complications (1.8%) were related to problems of insertion, and four (2.4%) represented the problem of pneumothorax after chest tube removal. The remaining eight complications (4.9%) were associated with positive bacterial cultures, two (1.2%) of which represented clinical empyema. Both cases of empyema had either prolonged chest tube placement (23 and 15 days) or multiple chest tubes (two and three) on the same side. Percutaneous chest tube thoracostomy remains an important facet in the management of certain types of blunt thoracic trauma. Associated risks can best be minimized with adherence to a standardized technique and management protocol.     

Post-traumatic ventricular septal defect following coronary bypass surgery

A 60-year-old patient underwent triple coronary artery bypass grafting following an inferoseptal myocardial infarction and early onset of exertional angina. Four years later he was involved in a car accident during which he sustained an abdominal and thoracic trauma. Approximately 1 month after discharge, a ventricular septal defect was diagnosed by two-dimensional Doppler echocardiography with patency of all grafts at coronary angiography. Closure of the septal defect was successfully accomplished through a right atrial approach. Rupture of the ventricular septum following blunt chest trauma in a patient with previous myocardial revascularization has not been previously reported.     

Combined dissection of the right coronary artery and right coronary cusp during coronary angiography

Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described. © 1995 Wiley-Liss, Inc.     

Coronary artery dissection—A complication of cardiac catheterization without sequelae: Case report and review of the literature

This report describes an acute right coronary artery dissection occurring during diagnostic cardiac catheterization. Following catheter manipulation in the vicinity of the aortic valve, the patient complained of mild chest discomfort and had transient electrocardiographic evidence of acute inferior wall myocardial infarction with runs of 2:1 atrioventricular block. Within 5 min, the EKG reverted to precatheterization appearance, and the patient was asymptomatic. Coronary angiography revealed a dissection of the proximal vessel without obstruction. The patient had no clinical sequelae while monitored in the intensive care unit. The patient underwent elective aortic and mitral valve replacement. The area of the dissection was directly visualized, and no abnormality was noted. We review the literature of spontaneous and iatrogenic coronary artery dissections with regard to pathology, diagnosis, and prognosis, and make recommendations for therapy.     

Rupture of the pericardium presenting as postpericardial trauma syndrome late after blunt chest injury

A 40-year-old man presented with a clinical picture of postpericardial trauma syndrome six weeks after blunt injury to the chest. Posttraumatic pericardial rupture was diagnosed at exploratory thoracotomy. The presence of aortic regurgitation due to a previously undiagnosed congenital sinus of Valsalva aneurysm complicated the clinical picture. To our knowledge this is the first report of postpericardial trauma syndrome associated with pericardial rupture after blunt chest injury. It emphasizes the high index of suspicion required for diagnosis of pericardial rupture, a condition with potentially lethal complications.     

Chest pain variant asthma

We present the cases of three patients who initially presented with chest pain but were ultimately diagnosed as having asthma. None had audible wheezing. A diagnosis of asthma was entertained and ultimately supported by a clinical response to bronchodilator therapy. Only one patient had significant but intermittent documentable reversible airway obstruction, while another had marked sensitivity to methacholine bronchial challenge. Two patients required short courses of oral corticosteroids before symptom ablation.     

Left anterior descending artery dissection: a rare sequela of blunt chest trauma

Traumatic coronary artery (CA) dissection is an extremely rare sequela of blunt chest trauma. Diagnosis of CA dissection in the setting of chest trauma is challenging. While conventionally coronary angiography has been the diagnostic tool of choice, modern imaging techniques such as optical coherence tomography can further improve diagnostic accuracy and help optimise treatment strategy. The ideal treatment modality for managing CA dissection has not been established with case reports revealing a range of treatment strategies ranging from CA bypass grafting to a completely conservative management. Here we present a case report of a 68‐year‐old man who suffered a traumatic proximal left anterior descending artery dissection as a consequence of a motor‐vehicle accident and was subsequently treated with a combination of conservative and interventional strategy with optimal patient outcome.     

Acute myocardial infarction following blunt chest trauma

A 32-year-old male riding a motorcycle was involved in an accidentresulting in blunt torso trauma. He had fractures of the skull,first right rib, and left femoral bone. Electrocardiogram showedacute anteroseptal myocardial infarction (MI). Subsequent coronaryangiogram demonstrated laceration at the proximal portion ofthe left anterior descending coronary artery. Echocardiogramshowed depressed left ventricular function as well as hypokinesisover septal and apical areas. His recovery was smooth.