Coronary Intramural Hematoma in a Young Athlete After Direct Ball Impact to the Chest.

BACKGROUND

Coronary intramural hematoma (IMH) is a rare cause of acute coronary syndrome that may occur after blunt chest impact.

CASE SUMMARY: A 19-year-old competitive athlete presented with sudden retrosternal chest pain after intense exertion and direct ball-related impact to the chest during a football match. Troponin peaked at 20,400 ng/L. Coronary angiography showed a nonobstructive ostial left anterior descending artery (LAD) lesion. Cardiac magnetic resonance demonstrated near-transmural ischemic injury with microvascular obstruction in the basal-mid septum. Coronary computed tomography (CT) angiography revealed hyperdense mural thickening and positive remodeling of the proximal LAD, suggestive of IMH. Optical coherence tomography confirmed a focal subadventitial IMH in the proximal LAD, near the ostium of the first septal branch.

DISCUSSION: This case illustrates traumatic IMH as a potential cause of myocardial infarction with nonobstructive coronary arteries in a young athlete and underscores the value of cardiac CT.

TAKE-HOME MESSAGES: Coronary IMH should be considered after blunt chest trauma. Noncontrast CT aids IMH diagnosis.