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Coronary Intramural Hematoma in a Young Athlete After Direct Ball Impact to the Chest
Hichem Sakhi1, Laurette Kalifa1, Sahbi Fradi2
1Medical Imaging Department, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
Background:
Coronary intramural hematoma (IMH) is a rare cause of acute coronary syndrome that may occur after blunt chest impact.
Case Summary:
A 19-year-old competitive athlete presented with sudden retrosternal chest pain after intense exertion and direct ball-related impact to the chest during a football match. Troponin peaked at 20,400 ng/L. Coronary angiography showed a nonobstructive ostial left anterior descending artery (LAD) lesion. Cardiac magnetic resonance demonstrated near-transmural ischemic injury with microvascular obstruction in the basal-mid septum. Coronary computed tomography (CT) angiography revealed hyperdense mural thickening and positive remodeling of the proximal LAD, suggestive of IMH. Optical coherence tomography confirmed a focal subadventitial IMH in the proximal LAD, near the ostium of the first septal branch.
Discussion:
This case illustrates traumatic IMH as a potential cause of myocardial infarction with nonobstructive coronary arteries in a young athlete and underscores the value of cardiac CT.
Take-Home Messages:
Coronary IMH should be considered after blunt chest trauma. Noncontrast CT aids IMH diagnosis.
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