case_images: PMC10508907_01
case_images: The fracture site and dynamic changes of electrocardiogram. (A) Left 4th-6th rib fracture indicated by the arrow. (B) Admission electrocardiogram. (C) Post PCI electrocardiogram. (D) Discharge electrocardiogram.
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case_images: PMC10508907_01_fcvm-10-1226129-g001.jpg
case_images: F1
case_images: Emergency CT examination revealed discontinuity of the left axillary segment of the 4th-6th rib (Figure 1A); discontinuity of the right anterior segment of the 6th-7th rib, axillary segment, and posterior segment of the 8th-9th rib; fracture of the left transverse process of L1-2 and L4-5; fracture of the pelvis; multiple fractures of the left upper femur; fracture of the left tibial plateau and left foot. Upon admission, an ECG suggested QS pattern and ST-segment elevation in leads V1-V4, I, and aVL (Figure 1B). T-wave inversion in leads V4-V6, I, and aVL (Figure 1C). The patient's chest pain improved after stenting. T-wave inversion flattening in leads V4-V6, I, and aVL (Figure 1D) (compared with admission).
case_images: Dynamic changes in cardiac enzymes and hsCRP during hospitalization.
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case_images: PMC10508907_01_fcvm-10-1226129-g002.jpg
case_images: F2
case_images: As a result, the possibility of acute myocardial infarction was considered upon review of the case data (Figure 2).
case_images: Coronary angiography of the patient. (A,B) The arrow showed a dissection in the left anterior descending artery, and no stenosis was seen in the left circumflex artery. (C) The right coronary artery was normal. (D) Coronary angiography was repeated after stenting, and no luminal stenosis was seen at the arrow, and the dissection was closed.
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case_images: PMC10508907_01_fcvm-10-1226129-g003.jpg
case_images: F3
case_images: TIMI grade 3 antegrade flow, and a large convex lumen with a clear, high-bright band visible in the vessel lumen, which suggested the presence of a dissection hematoma compressing the proximal segment lumen. The left circumflex artery (LCX) and right coronary artery (RCA) were normal (Figures 3A-C). A repeated angiography indicated that the stent was successfully deployed, and there was TIMI3 forward blood flow (Figure 3D).
case_images: Optical coherence tomography of the patient. (A) An opening tear length of 1.95 mm in the left anterior descending artery. (B) The solid white line is the dissection hematoma, and the solid blue line is the true lumen area of the vessel, with an area of 11.72 mm2 and 9.46 mm2 respectively. (C) The white solid line area is the minimum area of 7.99 mm2 for the real lumen. (D) The stent was well apposed to the wall, with an area of 22. 17 mm2.
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case_images: PMC10508907_01_fcvm-10-1226129-g004.jpg
case_images: F4
case_images: The dimensions of the coronary artery dissection were as follows: the length of the opening tear was 1.95 mm, the length of the entire dissection was 14.5 mm, the maximum area of the hematoma was 11.72 mm2, the area of the true lumen was 9.46 mm2, and the minimum true lumen area at the site of the dissection was 7.24 mm2 (Figures 4A-C). A repeat OCT showed good stent apposition against the wall, with no dissection or intracavitary hematoma (Figure 4D).