Iatrogenic STEMI in a male trauma patient due to coronary artery compression by a left sided chest tube

Abstract

Iatrogenic ST segment elevation myocardial infarction (STEMI) after insertion of a left sided thoracic tube is a rare insertional complication. We present a case of coronary artery compression of the left anterior descending artery (LAD) caused by a left sided chest tube placed after blunt thoracic trauma with pneumothorax resulting in a STEMI. A 53-year-old male patient with severe blunt thoracic trauma presented in the emergency department. After diagnosing a left sided pneumothorax in the primary survey according to ATLS, a chest drain was inserted. Shortly after insertion of the chest tube, a STEMI pattern appeared on the ECG (electrocardiogram). CT scans showed proximity of the chest tube to the LAD. Immediate pullback of the chest tube led to resolution of the electrocardiographic abnormalities. Complications after chest tube insertion can occur in up to 30 % of patients. However, no similar case with iatrogenic ST segment elevation myocardial infarction due to compression of a coronary artery has been reported in the literature so far. Knowledge of the possible complications of an intervention is important and a 'high level of suspicion' is required in order to recognize and resolve them quickly.

Keywords: Blunt thoracic trauma; Complication; STEMI; Thoracic drain; Thoracic tube.