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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary computed tomography-angiography for traumatic coronary artery transection
Kenta Nagashima1, Tomohiro Hayashida2, Eiji Yamada3
1Emergency Medical Center Fukuyama City Hospital Fukuyama Japan.
Insights
A rare cardiac stab wound with coronary artery transection was successfully treated. Preoperative diagnosis using computed tomography-angiography enabled life-saving coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Penetrating thoracic trauma is rarely fatal.
- Coronary artery transection is a rare but lethal injury.
- Successful treatment of cardiac stab wounds with coronary artery transection is possible with prompt diagnosis.
Observation:
- A 36-year-old male presented with a left chest stab wound.
- Computed tomography-angiography revealed left hemopneumothorax and left anterior descending artery transection.
- Ischemic changes were noted in the left ventricular myocardium.
Findings:
- Coronary artery bypass surgery was successfully performed using the left internal thoracic artery.
- The patient recovered well and was discharged 18 days post-surgery.
- No major complications were observed during the postoperative period.
Implications:
- Preoperative computed tomography scans with coronary angiography are valuable for diagnosing coronary artery injuries.
- This diagnostic approach aids in planning surgical interventions for high-risk patients.
- Early and accurate diagnosis can lead to successful outcomes in rare, severe cardiac trauma cases.
Background:
Penetrating thoracic trauma with coronary artery transection is a lethal injury, but is rare. We report a case of a cardiac stab wound with coronary artery transection that was successfully treated after preoperative diagnosis.
Case Presentation:
A 36-year-old man was transferred to our emergency department with a left chest stab wound. A coronary computed tomography-angiography scan, including coronary angiography, revealed left hemopneumothorax and left anterior descending branch transection, with ischemic changes in the left ventricular myocardium. Given the diagnosis of coronary artery transection and the absence of injury to the surrounding arteries, we were able to perform coronary artery bypass surgery using the left internal thoracic artery. The patient's postoperative course was good, and he was discharged on foot without major complications 18 days after surgery.
Conclusion:
Unless a resuscitative thoracotomy is required, a preoperative computed tomography scan, including coronary angiography, may be useful for accurate preoperative diagnosis for patients at high risk of myocardial or coronary artery injury.
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