Table 1.
Summary of reported cases of coronary artery rupture in blunt thoracic trauma
| Reference | Age & gender | Mechanism of injury | Diagnosis | Presentation | Artery involved | Associated cardiac injuries | Pericardial defect | Coronary artery disease | Management | Time windowa | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Goffin et al. 1974 [11]. | 62 M | MVC | Autopsy | Dyspnea, chest pain, shock. CXR: Multiple rib fractures. Slight enlargement of the heart. ECG changes of inf. MI and AV block. Moderately elevated CPK and SGOT. |
RCA | Aortic tear. Intimal tear in LCX | Present | Present | Pericardiocentesis (failed) | 9.5 h | Died |
| Trotter et al. 1998 [9]. | 15 M | MVC | Intraop. | Chest wall contusion. Continuous murmur. Initially stable vital signs, then worsening dyspnea and cardiogenic shock. CXR: widened cardiac silhouette. RBB on ECG. |
RCA | Tricuspid valve | Present | N/Ab | ACB | 8 h | Survived |
| Suzuki et al. 2000 [6]. | 59 M | FD | Autopsy | Severe dyspnea and chest pain 14 h after the incident. CXR: fractures of left 7th and 8th ribs with left pleural effusion. | LAD | None | Present | N/Ab | None | 17 h | Died |
| Dimopoulos et al. 2003 [16]. | 78 F | FD | Autopsy | Anemia. Massive left pleural effusion on CXR. Atrial fibrillation and LBBB. Echocardiogram: 700 ml of pericardial effusion with normal ejection fraction. |
ICA | None | N/Ab | N/Ab | None | N/A | Died |
| Straub et al. 2003 [10]. | 71 M | FD | Intraop. | No visible chest wall lesions. Cardiogenic shock. CXR: normal. Elevated cardiac enzymes. Echocardiography: pericardial effusion, no wall motion disturbances. CT scan: hemorrhagic pericardial effusion and para-aortic contrast fluid extravasation. |
RCA | None | None | Present | OPCAB | 14 h | Died |
| Sugimoto et al. 2003 [17]. | 34 M | MVC | Intraop. | Unconscious and in severe shock. Echocardiogram: massive hemopericardium. |
RCA | None | N/Ab | N/Ab | ER thoracotomy with attempted ligation of the RCA. Interval ACB three weeks later. | No delay | Survived |
| Dueholm et al. 2009 [12]. | 44 M | MVC | Autopsy | Chest pain. Normal exam. ECG: Acute MI. CXR: Fractures in left 6th and 7th ribs. Arrhythmia, followed by cardiogenic shock. |
RCA | None | N/Ab | Present | None. | 56 h | Died |
| Tyson et al. 2010 [7]. | 69 M | MVC | Intraop. | Breath sounds decreased on the left. CXR: left hemothorax and widened mediastinum. CT scan: minimal pericardial fluid. Fractures in left 2nd -7th ribs. Tube thoracostomy drained 2 L of blood. | OM | Posterior cardiac vein | Present | N/Ab | Anterolateral thoracotomy and ligation of bleeding vessels. | 2 h | Survived |
| Burcar et al. 2013 [18]. | 15 M | MVC | Intraop. | Chest wall hematomas. GCS 5/15. Hypotension. ST segment depression. Troponin I & CPK elevation. Bilateral lung contusions on CT scan. | LM | Intimal tear in MPA | N/Ab | N/Ab | Sternotomy. Pericardiotomy. LIMA to LAD. SVG to LCX. |
N/A | Died |
MVC motor vehicle collision, FD falling down, LAD left anterior descending artery, RCA right coronary artery, LCX circumflex artery, ICM intermediate coronary artery, OM obtuse marginal artery, LM left main coronary artery, MPA main pulmonary artery, ACB aortocoronary bypass, OPCAB off pump coronary artery bypass, LIMA left internal mammary artery, SVG saphenous vein graft
aTime window between injury and intervention or death
bNo explicit information about the finding was provided in the case report