Traumatic septal coronary perforation after a motor vehicle collision

Description

A 21-year-old man presented to our institution after a motor vehicle collision. His vitals were normal. He had normal heart sounds with no murmurs.

Electrocardiogram (EKG) showed ST-segment elevations in leads I, AVL.,V1 to V3. Troponin was elevated at 1810 ng/L (<15 ng/L). Chest CT revealed multiple rib fractures and a haematoma in the antero-septum of the left ventricle (LV). An echocardiogram revealed mild LV systolic dysfunction with a severely hypokinetic septum and moderate right ventricular (RV) systolic dysfunction. Coronary angiogram showed no evidence of atherosclerosis. There was a traumatic dissection of the second diagonal artery and septal coronary perforation with shunting into the RV (figure 1, videos 1 and 2).

Figure 1

(A) 3D CT reformat demonstrating haematoma adjacent to LAD. (B) Axial CT demonstrating haematoma adjacent to right ventricle (arrowhead). (C) Resolution of haematoma at 3-month (asterisk). (D) Septal haematoma...

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