Rupture of the coronary artery after blunt nonpenetrating chest wall trauma detected by color Doppler echocardiography: A case report

We report a rare case of a ruptured papillary muscle of the anterior leafle t of the tricuspid valve and the rupture of the septal branch of the left a nterior descending coronary artery with drainage into the right ventricle a fter blunt nonpenetrating chest wall trauma. Both abnormalities were detect ed by transthoracic 2-dimensional and color Doppler echocardiography, and t he septal branch rupture was confirmed by coronary angiography. The leading echocardiographic sign of the rupture of the coronary artery was intramyoc ardial mosaic-colored now, representing the turbulent high-velocity now in the ruptured coronary artery. Hypokinesis of the anteroseptal myocardial se gments and the presence of Q waves in leads V1 through 4 on the electrocard iogram were suggestive of anteroseptal myocardial infarction. We conclude t hat the history of chest trauma, the electrocardiographic changes, and wall motion abnormalities should be stimuli for a careful color Doppler now "ma pping" of the myocardium for possible identification of a corollary artery rupture.