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      Traumatic left main coronary artery dissection in a young adult following blunt chest trauma – A case report

      case-report
      , MD a , 1 , , MD b , 1 , , MD c , 1 , *
      Radiology Case Reports
      Elsevier
      Coronary artery dissection, Blunt chest trauma

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          Abstract

          Blunt chest trauma may cause variable degrees of thoracic injuries. Most of the patients may remain asymptomatic after sustaining blunt chest trauma. But in rare instances, life-threatening conditions such as coronary artery dissection may occur. The authors present a 29-year-old male adult with persistent chest pain following blunt trauma with a rise in cardiac troponins and elevated ST segment in ECG. Coronary CT and conventional angiography demonstrated dissection of the left main coronary artery. It is deemed necessary to suspect cardiac injury in patients with a history of blunt chest trauma in appropriate clinical settings. Early recognition of coronary artery dissection is vital to reduce morbidity and mortality. ECG combined with cardiac enzymes can be essential tools helping the physicians raise the suspicion towards a cardiac injury followed by cross-sectional and conventional angiographies for confirmation.

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          Most cited references9

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          The sigmoid volvulus: surgical timing and mortality for different clinical types

          Background In western countries intestinal obstruction caused by sigmoid volvulus is rare and its mortality remains significant in patients with late diagnosis. The aim of this work is to assess what is the correct surgical timing and how the prognosis changes for the different clinical types. Methods We realized a retrospective clinical study including all the patients treated for sigmoid volvulus in the Department of General Surgery, St Maria Hospital, Terni, from January 1996 till January 2009. We selected 23 patients and divided them in 2 groups on the basis of the clinical onset: patients with clear clinical signs of obstruction and patients with subocclusive symptoms. We focused on 30-day postoperative mortality in relation to the surgical timing and procedure performed for each group. Results In the obstruction group mortality rate was 44% and it concerned only the patients who had clinical signs and symptoms of peritonitis and that were treated with a sigmoid resection (57%). Conversely none of the patients treated with intestinal derotation and colopexy died. In the subocclusive group mortality was 35% and it increased up to 50% in those patients with a late diagnosis who underwent a sigmoid resection. Conclusions The mortality of patients affected by sigmoid volvulus is related to the disease stage, prompt surgical timing, functional status of the patient and his collaboration with the clinicians in the pre-operative decision making process. Mortality is higher in both obstructed patients with generalized peritonitis and patients affected by subocclusion with late diagnosis and surgical treatment; in both scenarios a Hartmann's procedure is the proper operation to be considered.
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            Traumatic coronary artery dissection: potential cause of sudden death in soccer.

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              Traumatic Coronary Artery Dissection with Secondary Acute Myocardial Infarction after Blunt Thoracic Trauma

              We report the case of a 41-year-old male with traumatic coronary artery dissection after a high-speed motor vehicle collision. Computed tomography imaging revealed multiple intracranial subdural and subarachnoid bleedings, a skull base fracture and multiple bilateral rib fractures. There was no pericardial hemorrhage, haemothorax or pneumothorax. No intra-abdominal lesions were found. A 12-lead electrocardiogram on arrival showed an acute myocardial infarction. Emergency angiography showed complete dissection of the right coronary artery without reflow after placement of 6 coronary stents. The patient passed away the day after. In retrospective, the right coronary dissection was visible on the trauma CT-scan.
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                Author and article information

                Contributors
                Journal
                Radiol Case Rep
                Radiol Case Rep
                Radiology Case Reports
                Elsevier
                1930-0433
                04 February 2022
                April 2022
                04 February 2022
                : 17
                : 4
                : 1190-1193
                Affiliations
                [a ]Department of Radiology, Thoracic imaging, Ege University Hospital, Faculty of Medicine, Izmir, Turkey
                [b ]Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
                [c ]Radiology department, Wyagal Radiology Center, Kabul, Afghanistan
                Author notes
                [* ]Corresponding author. Naqibfoladi@ 123456gmail.com
                [1]

                The authors are submitting the article from Afghanistan; a low-income country and eligible for publication fee waiver; a policy Elsevier is following. Hence, we request for publication fee waiver, if the manuscript is accepted for publication

                Article
                S1930-0433(22)00016-4
                10.1016/j.radcr.2022.01.016
                8829528
                7441a834-50e9-4dbe-832d-16f2b0dbc603
                © 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 23 December 2021
                : 9 January 2022
                : 12 January 2022
                Categories
                Case Report

                coronary artery dissection,blunt chest trauma
                coronary artery dissection, blunt chest trauma

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