Devil and the Deep Blue Sea: Concomitant Coronary Artery Dissection and Intracranial Hemorrhage in a Trauma Patient

Serene Goh Si Ning1,2*, Abdul Kareem Saleem Ahmed1 and Teo Li Tserng1

1Department of General Surgery, Tan Tock Seng Hospital, Singapore
2MOH Holdings, 1 Maritime Square, Singapore

^*Correspondance to: Serene Goh Si Ning 

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Abstract:

Introduction: Coronary Artery Dissection (CAD) is an uncommon complication of BCI with less
than 20 cases reported in literature. Conservative management maybe successful in selected patients,
whilst others require coronary artery stenting, bypass and/or anticoagulation. The management of
traumatic CAD becomes more complex in patients with concomitant injuries with risk of bleeding.
Methods: A 65-year-old lady sustained CAD of the Left Circumflex Artery (LCx) with concomitant
intracranial hemorrhage following a Motor-Vehicle Accident (MVA). She had momentary
loss of consciousness and complained of chest pain. On examination she had tenderness to the
left of her sternum. FAST was negative and Chest XR demonstrated left 10th rib fracture with no
hemopneumothorax. Electrocardiogram demonstrated ST-T segment elevation in leads II, III, aVF
and ST segment depression in V1-V3 compatible with posterior STEMI. She was given aspirin prior
to brain imaging. CT brain showed hemorrhagic contusion in the right cingulate gyrus and trace
sub-arachnoid hemorrhage. She underwent cardiac catherization, diagnostic angiogram revealed
complete occlusion of the Left Circumflex Artery (LCx) suggestive of dissection. Plain angioplasty
did not restore flow and stenting was not performed in view of contraindications to antiplatelet
therapy.
Discussion/Conclusion: CAD following blunt chest trauma is rare but potentially devastating,
requiring high index of suspicion. We performed a literature search of relevant articles in English
on PubMed as there is currently no consensus on the evaluation and management of traumatic
CAD with concomitant injuries. We suggest a flowchart for management of multi-injured patients
based on hemodynamic status.

Keywords:

Coronary artery dissection; Blunt cardiac injury; Polytrauma

Cite the Article:

Ning SGS, Ahmed AKS, Tserng TL. Devil and the Deep Blue Sea: Concomitant Coronary Artery Dissection and Intracranial Hemorrhage in a Trauma Patient. World J Surg Surgical Res. 2020; 3: 1250..