DÄ internationalArchive33-34/2019Dressler Syndrome in Anterior Myocardial Infarction Due To Traumatic Coronary Artery Dissection

Clinical Snapshot

Dressler Syndrome in Anterior Myocardial Infarction Due To Traumatic Coronary Artery Dissection

Dtsch Arztebl Int 2019; 116: 562. DOI: 10.3238/arztebl.2019.0562

Dreger, H; Haug, M; Möckel, M

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a) Axial contrastenhanced computed tomography showing serous pericardial effusion (20 HU) and left ventricular apical thrombus (arrowheads). b) Coronary angiography (postero - anterior caudal) with longitudinal narrowing of the lumen of the left anterior descending artery (arrowheads). Bottom left: Optical coherence tomography (OCT) showing coronary dissection as a result of the blunt thoracic trauma.
a) Axial contrastenhanced computed tomography showing serous pericardial effusion (20 HU) and left ventricular apical thrombus (arrowheads). b) Coronary angiography (postero - anterior caudal) with longitudinal narrowing of the lumen of the left anterior descending artery (arrowheads). Bottom left: Optical coherence tomography (OCT) showing coronary dissection as a result of the blunt thoracic trauma.
Figure
a) Axial contrastenhanced computed tomography showing serous pericardial effusion (20 HU) and left ventricular apical thrombus (arrowheads). b) Coronary angiography (postero - anterior caudal) with longitudinal narrowing of the lumen of the left anterior descending artery (arrowheads). Bottom left: Optical coherence tomography (OCT) showing coronary dissection as a result of the blunt thoracic trauma.

A 36-year-old male physician presented to our emergency department with back pain after a fall while exercising on a trampoline. A fracture was excluded by X-ray and the patient was discharged. Two weeks later the patient presented again, this time with progressive fatigue, a temperature of up to 39.3°C, and thoracic pain on respiration. Clinical chemistry found elevated parameters of inflammation (leukocytes 16.9/nL, C-reactive protein [CRP] 159 mg/L). Echocardiography revealed a 3-cm pericardial effusion and an apical hypokinesia with left ventricular thrombus; computed tomography showed corresponding morphological findings. After pericardiocentesis, cardiac catheterization demonstrated traumatic dissection of the left anterior descending coronary artery with older thrombi, which was then treated by implantation of a stent. Inflammatory markers normalized under antiphlogistic therapy. The patient was discharged after 2 weeks with mild exercise dyspnea.

Dressler syndrome is an autoimmune-mediated pericarditis that rarely occurs nowadays but was observed in around 3% of post-infarction patients a few weeks after the myocardial damage before the advent of modern reperfusion treatment.

Prof. Dr. med. Henryk Dreger, Dr. med. Marcel Haug, Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Charité Mitte, Charité—Universitätsmedizin Berlin, henryk.dreger@charite.de

Prof. Dr. med. Martin Möckel, Arbeitsbereich Notfall- und Akutmedizin, Campus Virchow Klinikum und Campus Charité Mitte, Charité—Universitätsmedizin Berlin

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Dreger H, Haug M, Möckel M: Dressler syndrome in anterior wall infarction following traumatic coronary artery dissection.
Dtsch Arztebl Int 2019; 116: 562. DOI: 10.3238/arztebl.2019.0562

a) Axial contrastenhanced computed tomography showing serous pericardial effusion (20 HU) and left ventricular apical thrombus (arrowheads). b) Coronary angiography (postero - anterior caudal) with longitudinal narrowing of the lumen of the left anterior descending artery (arrowheads). Bottom left: Optical coherence tomography (OCT) showing coronary dissection as a result of the blunt thoracic trauma.
a) Axial contrastenhanced computed tomography showing serous pericardial effusion (20 HU) and left ventricular apical thrombus (arrowheads). b) Coronary angiography (postero - anterior caudal) with longitudinal narrowing of the lumen of the left anterior descending artery (arrowheads). Bottom left: Optical coherence tomography (OCT) showing coronary dissection as a result of the blunt thoracic trauma.
Figure
a) Axial contrastenhanced computed tomography showing serous pericardial effusion (20 HU) and left ventricular apical thrombus (arrowheads). b) Coronary angiography (postero - anterior caudal) with longitudinal narrowing of the lumen of the left anterior descending artery (arrowheads). Bottom left: Optical coherence tomography (OCT) showing coronary dissection as a result of the blunt thoracic trauma.