Coronary Artery Dissection Accompanied by Acute Myocardial Infarction and Myocardial Contusion Secondary to Blunt Chest Trauma

We report the case of a 17-year-old young woman who developed acute myocardial infarction with myocardial contusion following a blunt chest trauma sustained in a motorcycle accident. The chest roentgenogram on admission was normal. Electrocardiogram showed complete right bundle branch block and pathologic Q waves with ST elevation in leads I, aVL and V1 to V5. Two-dimensional echocardiogram revealed akinesis of the anterior wall and hypokinesis of the posterior wall of the left ventricle, consistent with extensive anterior myocardial infarction with myocardial contusion of the posterior wall. Coronary angiography revealed an abrupt, severe stenosis with delayed antegrade filling in the proximal left anterior descending artery, suggesting an intimal flap in the vessel wall. Technetium-99m pyrophosphate myocardial scintigraphy demonstrated diffuse tracer uptake in the left ventricular wall. Follow-up coronary angiography performed one year after the accident showed only minor stenosis without any filling defects of contrast medium at the site of the initial lesion. In this report, we discuss the spontaneous resolution of coronary artery dissection due to a blunt chest trauma together with its management and treatment.