Unusual presentation of acute coronary syndrome. Bilateral coronary dissection after car accident

Dissection of large and small vessels can be caused by deceleration trauma. Management of dissections is often difficult technically, and invasive interventions are associated with complications. We report the case of a 45-year-old woman admitted with acute coronary syndrome after a car accident and deceleration trauma. The coronary angiogram showed a focal stenotic dissection of the left main and a long nonstenotic dissection of the right coronary artery. Aortography was normal. After a complicated but finally successful angioplasty, the patient developed an abdominal hemorrhagic complication due to her previous trauma, which required urgent laparotomy; spleen was then removed and laceration on liver surface was surgically repaired. The patient developed a severe coagulopathy after surgery, which led to an irreversible stage and death within 24 hours.