Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary
Go Inokuchi1, Yohsuke Makino2,3, Ayumi Motomura2
1Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture, 260-8670, Japan. goinokuchi@chiba-u.jp.
Insights
Blunt chest trauma can cause fatal coronary artery rupture, often missed by external exams and postmortem CT. Postmortem coronary angiography revealed right coronary artery rupture, aiding forensic diagnosis.
Area of Science:
- Forensic Pathology
- Cardiovascular Imaging
- Trauma Medicine
Background:
- Coronary artery injury is a rare but potentially fatal complication of blunt chest trauma (BCT).
- Determining the cause of death in cases of BCT can be challenging, especially when external signs of injury are minimal.
- Postmortem computed tomography (PMCT) may not always reveal subtle cardiac or coronary artery damage.
Observation:
- A case of fatal right coronary artery rupture following blunt chest trauma is presented.
- Initial examination, including postmortem computed tomography (PMCT), did not reveal the fatal injury.
- Subcutaneous hemorrhage and cardiac contusions indicated external force applied to the chest.
Findings:
- Postmortem selective coronary angiography identified intimal irregularity and a filling defect in the right coronary artery.
- Histopathology confirmed coronary rupture with medial dissection and lumen compression.
- This is the first reported case of coronary artery rupture with dissection detected by CT coronary angiography.
Implications:
- This case highlights the importance of advanced imaging in forensic investigations of unexplained deaths after trauma.
- CT coronary angiography can be crucial for diagnosing subtle yet fatal coronary artery injuries.
- Accurate diagnosis is vital to prevent overlooking criminality and ensure appropriate forensic and clinical management.
Abstract:
Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.
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