Selective penetrating injury of the right coronary artery: a fatal case

Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest

Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.

A fatal stab wound causing selective injury to the left anterior descending coronary artery, myocardial infarction and delayed cardiac tamponade

We describe an unusual case of delayed cardiac tamponade that led to death 9 days after a penetrating stab wound. The injury consisted of a longitudinal tear in the LAD coronary artery, with an occlusive thrombus and the rupture of the coronary wall into a pseudo-aneurysmatic peri-coronary hematoma. As imaging evidence of pericardial effusion and ischemic electrocardiographic changes were lacking, the diagnosis was only made during post-mortem examination.