Among the causes of death in all age groups, deaths due to trauma rank third after cardiovascular diseases and cancer. Until age 40, chest trauma constitutes 20-25% of the causes of deaths due to trauma. Blunt cardiac trauma develops frequently following motor-vehicle accidents and its mortality rate is high. Of all types of cardiac injury that can result from blunt chest trauma, coronary artery dissection is the most infrequent one. The consequences of coronary artery dissections are variable, ranging from none or mild myocardial infarction to massive myocardial infarction or death. We report two unusual cardiac complications of blunt chest trauma: a traumatic dissection in both left anterior descending artery (LAD) and right coronary artery (RCA), concomitant with tricuspid insuffi ciency due to papillary muscle rupture. The management of the patient had to be tailored due to the complexity of the presentation. The fi nal treatment plan resulted in uneventful clinical course and good overall medical results.

A seventy-nine year old Caucasian male with a diagnosis of chronic lymphocytic leukemia presented with acute tumor lysis syndrome after treatment with two courses of fl udarabine and one course of rituxan. In this article we report this rare complication, which has been reported only few times in the literature, and discuss the ways to prevent it from happening.