Correspondence

Coronary Arterial Laceration after Blunt Chest Trauma

N Engl J Med 2000; 343:742-743September 7, 2000

Article

To the Editor:

There are few reports describing nonpenetrating cardiac injuries other than those caused by automobile and motorcycle accidents.1 We describe a patient who had an isolated coronary arterial laceration as the result of a fall.

A 59-year-old man who was receiving warfarin because of previous aortic- and mitral-valve replacements sustained blunt chest trauma by falling 50 cm onto a metal wheelbarrow. Two hours later, he came to our hospital. On examination, the findings were identical to those at his last outpatient visit, except for fractures of the anterolateral left seventh and eighth ribs. Fourteen hours after the accident, he returned to our hospital with severe dyspnea and chest pain. Laboratory findings included a hematocrit of 20 percent and an international normalized ratio of 2.0. The chest x-ray film and computed tomographic scans showed a massive pleural effusion with rightward shift of the mediastinum and protrusion of the left ventricle through a pericardial rent. The patient died 17 hours after the accident. A postmortem examination showed a 2-mm-long laceration, which seemed to be the only site of active bleeding, of the left anterior descending coronary artery 8 cm from its origin (Figure 1Figure 1Laceration of the Left Anterior Descending Coronary Artery.).

Laceration or rupture of the coronary artery as a result of blunt trauma is a rare finding, except at autopsy.2-4 Isolated coronary arterial laceration and minimal myocardial contusion can be asymptomatic.5 The coronary arterial laceration in our patient was probably caused by direct trauma during the fall. He was pushing a metal wheelbarrow, and his chest struck it forcefully when he fell, fracturing two ribs. The fractured ribs caused a coronary arterial laceration that was only 2 mm in length. Because the patient had previously undergone cardiac surgery, there were dense adhesions between the pericardium and pleura, as well as a large defect in the pericardium. Since he was receiving warfarin as an anticoagulant, the lacerated vessel bled freely into the left hemithorax through the pericardial defect. Although the pericardial defect may have been partly responsible for the coronary arterial laceration, it also prevented the development of cardiac tamponade. This case illustrates that even small lacerations of the coronary artery can be fatal in patients who are taking anticoagulants.

Ichiro Suzuki, M.D.
Mamoru Sato, M.D.
Naoto Hoshi, M.D.
Hiroshi Nanjo, M.D.
Yuri Kumiai General Hospital, Akita 015-0051, Japan

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Citing Articles (1)

Citing Articles

1. 1

   A. Jaafari, B. Boukhriss, L. Zakhama, I. Medded, R. Zbiba. (2004) Dissection traumatique de la circonflexe compliquant une contusion myocardique. À propos d'une observation. Annales de Cardiologie et d'Angéiologie 53:5, 276-278
   CrossRef