Case report
Traumatic acute myocardial ischaemia involving two vessels

https://doi.org/10.1016/j.jflm.2014.01.013Get rights and content

Abstract

Myocardial infarctions caused by coronary artery injury after blunt chest trauma is a fatal, but rare occurrence. In the case reported on here, a fatally injured 69-year-old male driver sustained such trauma in a frontal car collision. The autopsy found a laceration of the left anterior descending artery as well as a subsequent subepicardial haematoma surrounding this artery and the circumflex artery. Using triphenyl tetrasolium chloride and hematoxillin-eosin stains, an acute myocardial ischaemia of the anterior left ventricle wall and the septum was diagnosed as the cause of death. Since coronary injuries affecting more than one vessel in blunt chest trauma are extremely rare, only a few papers have yet to refer to this type of coronary injury in addition to the case presented here.

Introduction

Fatally injured car occupants from frontal collisions are a common phenomenon in daily forensic practise. The most frequent causes of death include craniocerebral injuries and injuries of the thoraco-abdominal organs with consecutive fatal bleeding.1 The fast deceleration of the driver's body in frontal collisions generally leads to inertia continuing the movement of the body to collide with the steering wheel, the airbag, or the front windshield.

Among the fatally injured, the locus resistentiae minoris in the central mediastinum are the aorta and the lungs, usually followed by sternal and rib fractures. Heart injuries are not as frequent since the organ is protected by the sternum. However, when they do occur, ruptures of the heart wall lead to cardiac tamponade and to death. In addition to fatal cardiac ruptures, heart contusion and commotio cordis may be followed by arrhythmia, and heart failure, which also sometimes prove fatal.2, 3 Since myocardial infarctions caused by coronary artery dissection after blunt chest trauma are rare,4 only a few cases of fatal and non-fatal coronary artery injuries in blunt chest trauma have been described in the literature.

The left main coronary artery (LMCA) branches into the circumflex artery (CA), and the left anterior descending artery (LAD). The CA supplies blood to the left atrium, the side, and the back of the left ventricle, while the LAD supplies the front and bottom of the left ventricle, as well as the front of the septum. Therein, in the case under review here, an unusual fatal outcome of a driver from a frontal car collision is presented, in which an LAD laceration and subsequent acute myocardial infarction occurred.

Section snippets

Case report

According to the police report and the passengers' testimonies, a 69-year-old male driver died just 5–10 min after a car accident in which his vehicle collided into a tree alongside the road. No cardiopulmonary resuscitation was performed on the man. After the accident, the steering wheel was found to have become deformed. The car was an old Volkswagen model that had no airbag installed.

An outer examination of the body showed a congested head and neck with a few frontal excoriations and small

Discussion

Heart injuries caused by accidental car collisions encompass a spectrum of pathology ranging from clinically silent and transient dysrhythmias to the most frequent deadly outcomes.5 Chest pain is a common symptom after blunt chest injury, which may relate to chest contusions without any cardiac injury, or a myocardial infarction.4 The differentiation between a slight thoracic contusion and a significant cardiac injury is a challenge for any physician when attempting to assign an early diagnosis

Ethical approval

None declared.

Funding

None.

Conflict of interests

As it is based on the case from daily autopsy practise, authors did not have any support funding of the paper.

Authors did not have any financial benefits on publishing the paper, nor conflict of interests.

References (18)

There are more references available in the full text version of this article.
c

Tel.: +382 69 344 822.

View full text