Ulus Travma Acil Cerrahi Derg. 2018; 24(1): 78-81 | DOI: 10.5505/tjtes.2017.72393

Künt göðüs travmasý sonrasý koroner intramüral hematomun yayýlmasý

Maeng Real Park, Mun Ki Min, Ji Ho Ryu, Dae Sub Lee, Kang Ho Lee
Pusan Ulusal Üniversitesi, Yangsan Hastanesi, Acil Týp Kliniði, Yangsan, Güney Kore

Künt göðüs travmasý sonrasý koroner arter diseksiyonu ve intramüral hematom seyrek görülen, ancak yaþamý tehdit edici bir komplikasyondur. Koroner intramüral hematomun yayýlmasý ise çok daha seyrek görülür. Otuz bir yaþýndaki erkek yakýndaki bir hastaneye künt göðüs travmasý nedeniyle kabulü sýrasýnda kötüleþen sol göðüs aðrýsý nedeniyle hastanemize sevk edildi. Hasta baþý ekokardiyografisinde sol ventriküler apeks ve ön duvarda akinezi, sol ventrikül anteroseptal duvar ve arka duvarlarýnýn orta-alt bölümlerinde hipokinezi görüldü. Bilgisayarlý tomografi koroner anjiyografi sol ana koroner arter ve proksimal sol ön inen arterde intramüral hematomun varlýðýný gösterdi. Hematomun neden olduðu týkanýklýðý açmak için sol ana koroner arterden proksimal sol sirkumfleks (LCX) artere perkütan koroner giriþim (PKG) ile çýplak metal stent implante edildi. Stentlemeden sonra sol ana koroner arteri baskýlayan hematom LCX artere doðru yer deðiþtirdi. Yine intramüral hematom geliþti ve LCX’e uzandý. Bu týkanýklýðý çözmek için bir ilaç salan stent baþarýyla LCX arter içine implante edildi. Hasta komplikasyonsuz taburcu edildi. Ýzlemin ikinci ayýnda hasta semptomsuzdu ve hastada kardiyovasküler semptomlar nüksetmemiþti. Travma sonrasý geç dönemde oluþan göðüs aðrýsý koroner arter diseksiyonundan kuþkulandýrmalý ve hematomun geniþlemesine karþý dikkatli olunmalýdýr.

Anahtar Kelimeler: Göðüs travmasý, intramüral hematom; koroner arter diseksiyonu.

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Extension of a coronary intramural hematoma after blunt chest trauma

Maeng Real Park, Mun Ki Min, Ji Ho Ryu, Dae Sub Lee, Kang Ho Lee
Department of Emergency Medicine, Pusan National University Yangsan Hospital, Korea Yangsan-South Korea

Coronary artery dissection and intramural hematoma after blunt chest trauma are rare, but life-threatening, complications. Coronary intramural hematoma extension is even rarer. A 31-year-old man was transferred to our hospital for worsening left chest pain during while he was admitted at a nearby hospital due to blunt chest trauma. Bedside echocardiography showed akinesis of the left ventricular apex and anterior wall as well as hypokinesis of the mid-to-basal anteroseptal wall and mid-to-basal lateral and posterior walls of the left ventricle. Computed tomography coronary angiography revealed intramural hematoma in the left main (LM) coronary and proximal left anterior descending (LAD) arteries. Percutaneous coronary intervention, with bare metal stent implantation from the LM coronary artery to the proximal LAD artery, was performed to treat the occlusion caused by the hematoma. After stenting, the hematoma that compressed the LM coronary artery shifted the left circumflex (LCX) artery, and the intramural hematoma developed and extended to the LCX artery. To resolve this occlusion, a drug-eluting stent was successfully implanted in the LCX artery. The patient was discharged without complications. At 2-month follow-up, he remained asymptomatic, with no recurrence of cardiovascular symptoms. Delayed chest pain after trauma should be suspected during coronary dissection, and on treatment, care must be taken to extend the hematoma.

Keywords: Chest trauma, coronary artery dissection; coronary intramural hematoma.

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