Post Traumatic Pseudoaneurysm of Left Anterior Descending Artery Presenting as Acute Coronary Syndrome

Abstract

Penetrating cardiac injuries are highly lethal and carry high mortality rate. Both blunt and penetrating cardiac injuries in patients who survive are known to present with well-known sequelae that often appear days to weeks after the initial insult. In the literature there have been documented cases of cardiac injury induced myocardial infarction, ventricular aneurysms, valvular dysfunction and even fistulous tracts between the coronary vessels and chamber. Although the most commonly injured vessel is the left anterior descending (LAD) coronary artery, traumatic injuries to the left coronary artery result in early death in the majority of cases. We present a unique case of LAD pseudo aneurysm and stenosis presenting as acute coronary syndrome (ACS) months after the initial penetrating cardiac injury successfully managed by stenting. There are only few isolated case reports of coronary artery pseudoaneurysm following penetrating chest trauma published in English literature.

Coronary artery intramural hematoma causing myocardial infarction mimicking pseudoaneurysm or dissection from trauma: A case report

“…In cases with typical findings, a clear distinction between true and false lumens separated by an intimal flap may be observed in the contrast study. However, a pseudoaneurysm presents as an outpouching collection with a clearly defined neck that connects to the parent artery 14 . Importantly, these observations regarding the IMH and dissections are based on our own analyses and interpretations.…”

“…However, a pseudoaneurysm presents as an outpouching collection with a clearly defined neck that connects to the parent artery. 14 Importantly, these observations regarding the IMH and dissections are based on our own analyses and interpretations. Our observations provide a potential means of differentiating IMH from coronary artery dissection in the context of traumatic events.…”

ECG-Gated CCTA in the Assessment of Post-Procedural Complications

“…An aneurysm is defined as >1.5 times the normal arterial diameter, but pseudoaneurysms do not involve all layers of the vessel wall. Coronary pseudoaneurysms are mostly detected incidentally and are asymptomatic, but they can result in fistulae, rupture, bleeding, tamponade, and myocardial infarction; for these reasons, a prompt diagnosis is crucial [21], and CCTA allows for a correct definition of the size, morphology and location of the lesion.…”