Dissection of the anterior interventricular branch of the left coronary artery after blunt chest trauma in a car collision

History and admission findings: A 57-year-old man suffered a blunt trauma t o his chest when the car he was driving collided head-on with a stationary lorry. He had worn his seat belt and the air-bag had inflated on impact. He was admitted to hospital because of severe left chest pain that started 45 min after the accident. Admission physical examination indicated stable ca rdiopulmonary status in a fully conscious person with no obvious physical s igns, in particular no contusion or other injury to the chest or fractures. Investigations: EGG, echocardiography, chest radiography and routine labora tory tests on admission failed to reveal any diagnostic abnormality. But su bsequent ECC and biochemical tests suggested evolution of an acute anterior wall infarction, leading to the patient's transfer to the author's hospita l. Diagnosis and treatment: A coronary angiogram revealed traumatic dissection of the anterior interventricular branch (AIVB) around the origin of the fi rst diagonal branch. There was also suspicion of thrombus formation and cle arly impaired left ventricular function with hypo- to akinesia of the anter ior wall. Myocardial scintigraphy, positron emission tomography and stress echocardiography were performed to assess the possible need for interventio nal or surgical revascularization. They demonstrated functioning myocardial tissue in most of the anterior wall so that minimally invasive AIVB-bypass operation was planned. Conclusion: The possibility of severe injury of the heart and other organs even after primarily blunt chest trauma demands careful follow-up monitorin g and, if indicated, extensive noninvasive as well as invasive diagnosis an d treatment.