Case Report: Hematoma Formation After Spontaneous Coronary Artery Rupture

We report a case of hematoma formation in the right coronary artery after spontaneous rupture. A 48-year-old female patient was admitted with a suspected right cardiac mass. Despite diagnostic work-up, the dignity of the mass could not be determined. Due to acute clinical symptoms, explorative surgery was decided and performed. Hereby, the mass was partially incised, and thrombus-like tissue was detected without active bleeding. We described the challenges during the diagnostic process, and the diagnosis was finally made according to a multimodality approach. For further assessment, we reviewed related literature and highlighted the importance of coronary angiography in the preoperative evaluation of such patients. The therapy may vary according to the location and size of such lesions.

A very rare complication of subacute pericarditis: a case report of spontaneous coronary artery rupture

Background Spontaneous coronary artery rupture (SCAR) is an extremely rare and highly lethal disease. Case Summary A 74-year-old man who had undergone respiratory surgery (robot-assisted thoracoscopic surgery) presented with exertional dyspnoea since post-operative day (POD) 6. Echocardiography and contrast-enhanced computed tomography showed diffuse pericardial effusion, and a 12-lead electrocardiogram showed widespread concave ST-segment elevation. The diagnosis of acute pericarditis was made based on the absence of significant elevation of cardiac enzymes and the presence of elevated C-reactive peptide levels. The patient was started on anti-inflammatory medication, including steroids; however, on POD 11, the patient developed a sudden cardiopulmonary arrest due to cardiac tamponade. Extracorporeal cardiopulmonary resuscitation was performed, and an emergency coronary angiography showed contrast extravasation from the left anterior descending artery to the epicardium. He was diagnosed with SCAR and underwent transcatheter arterial embolisation (TAE) and pericardial drainage. Discussion In this case, SCAR occurred during the course of acute pericarditis. We speculated that the cause of SCAR was more affected with pericarditis than injury by the respiratory surgery. The clinical course of acute pericarditis generally has a good prognosis, but the rare occurrence of fatal complications should be considered, suggesting the need for careful follow-up. In addition, TAE was a less invasive and feasible treatment for SCAR.

A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site

Background Spontaneous coronary artery rupture (SCAR) is an extremely rare but life-threatening state. The aetiology and the pathologic findings remain to be fully elucidated. Case summary A 62-year-old woman, who had been on haemodialysis for 27 years, presented with chest discomfort worsening on deep inspiration that had been ongoing for the past 2 weeks. An echocardiogram and computed tomography showed diffuse pericardial fluid. ST elevation in the broad leads, especially in leads I, II, and aVF, and increased C-reactive peptide and Troponin I levels suggested pericarditis. The patient initially had a stable course with no medications. The chest symptoms disappeared and her vital signs were stable. On Day 13 after admission, however, she had a sudden cardiopulmonary arrest due to a cardiac tamponade. An emergency coronary angiography showed extravasation of the contrast into the epicardium from the branch of the circumflex artery. She was diagnosed with SCAR and underwent a successful coil embolization. However, she went into an irreversible coma due to the cerebral hypoxia. On Day 33, she died of pneumonia. An autopsy showed a rupture of the internal elastic layer of the coronary artery. However, no specific findings, such as aneurysm and dissection, were evident. The common atherosclerotic changes were observed. Discussion The stable condition lasting for over 2 weeks was a rare clinical course for SCAR. Long-term hypertension and dialysis would have caused the rupture of the coronary artery with common atherosclerotic changes. We should consider SCAR as one of the differential diagnoses when we observe pericardial fluid.