Fatal plaque rupture of mild atherosclerotic coronary artery following basketball-related blunt chest trauma: A case report with forensic disputes.

The rupture of coronary artery plaque is a pathological mechanism leading to acute coronary syndrome, typically associated with severe atherosclerosis and high hemodynamic stress, while cases induced by blunt chest trauma (BCT) are exceedingly rare. This report presents an unusual case of a young male who died shortly after an informal basketball game. Postmortem examination revealed mild atherosclerotic plaque with a lacerated fibrous cap, along with complete thrombotic occlusion in the proximal left anterior descending (LAD) artery. Some areas of the thrombus were in direct contact with the lipid and necrotic components of the plaque. Witness testimony indicated the presence of BCT. Moreover, focal epicardial hemorrhage around the LAD artery, along with microscopically identified subcutaneous hemorrhage in the chest wall skin further supported the occurrence of BCT. Ultimately, the cause of death was determined to be BCT-related plaque rupture and the subsequent thrombus formation in the LAD artery. Given the rarity of this phenomenon, the association between BCT and plaque rupture requires careful clarification and may lead to forensic disputes. This report aims to remind forensic pathologists to consider the possibility of plaque rupture following BCT when faced with similar cases.