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Extrinsic compression of the left main coronary artery: A rare cause of cardiogenic shock

Takashi Yamamoto1, Kentaro Yamashita1, Hiroaki Hagiwara2

  • 1Department of Cardiology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku Nagoya-shi, Aichi 460-0001, Japan.

Radiology Case Reports
|January 28, 2021
PubMed

Insights

A rare case of acute myocardial infarction caused by a mediastinal tumor compressing the left main coronary artery (LMCA) is presented. Surgical removal of the schwannoma relieved the compression, leading to a full recovery.

Area of Science:

  • Cardiology
  • Oncology
  • Thoracic Surgery

Background:

  • Left main coronary artery (LMCA) stenosis from extrinsic compression by mediastinal tumors is exceptionally rare.
  • Mediastinal masses can present with diverse and sometimes life-threatening cardiovascular complications.

Observation:

  • A 63-year-old woman presented with chest and back pain, ECG changes, and temporary shock.
  • Contrast-enhanced CT revealed a large cystic mediastinal mass compressing the LMCA, leading to acute myocardial infarction.

Findings:

  • CT angiography confirmed extrinsic compression of the LMCA by a mediastinal mass.
  • Histopathology identified the mass as a schwannoma.
  • Emergent tumor resection resulted in successful decompression of the LMCA.

Implications:

  • This case highlights the importance of considering extrinsic compression in LMCA stenosis, even with rare etiologies like mediastinal schwannomas.
  • Prompt diagnosis and surgical intervention are crucial for managing life-threatening cardiovascular compromise caused by mediastinal tumors.
  • Successful surgical decompression can lead to complete recovery and prevent further cardiac events.

Keywords:
Cystic massExternal compressionMediastinal tumorMyocardial infarctionSchwannoma

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