Spontaneous coronary artery rupture without a pericardial effusion: a diagnostic challenge

• Published in: BMJ case reports Vol. 2016; p. bcr2016214424
• Main Authors: Sevuk, Utkan, Ozyalcin, Sertan, Ayaz, Firat, Kose, Kaan
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 07.04.2016; BMJ Publishing Group
• Series: Case Report
• Subjects: Acute Coronary Syndrome - diagnosis; Acute coronary syndromes; Angina pectoris; Asia; Cardiac arrhythmia; Cardiovascular disease; Chest Pain - etiology; Coronary Angiography - methods; Coronary Artery Bypass; Coronary Artery Disease - diagnosis; Coronary Artery Disease - surgery; Coronary vessels; Diagnosis, Differential; Dissection; Heart attacks; Humans; Male; Medical imaging; Middle Aged; Pericardial Effusion; Rupture, Spontaneous; Unusual Presentation of More Common Disease/Injury; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-214424

Spontaneous coronary artery rupture (CAR) is an extremely rare, life-threatening entity. It is a challenge to make a diagnosis of CAR in the absence of pericardial effusion. We describe a case of a spontaneous rupture of the right coronary artery (RCA) without pericardial effusion that emphasises the benefit of high clinical suspicion and early diagnosis. A 60-year-old man was admitted to the emergency department, with inferior myocardial infarction. Echocardiogram was negative for a pericardial effusion. Coronary angiography revealed complete occlusion of the RCA with intraluminal dissection and extravasation of contrast into the epicardium at the mid-portion of the RCA, which suggested rupture of the RCA. The patient underwent uneventful emergency coronary artery bypass grafting. CAR should be considered as a differential diagnosis in patients with acute chest pain, even in the absence of pericardial effusion, particularly in case of inferior wall involvement.