A case of acute myocardial infarction due to coronary artery compression by mediastinal hematoma associated with thoracic aortic aneurysm rupture

Abstract A 76-year-old woman was admitted to our department for pneumonia. Although she gradually recovered, she complained of chest and back pain and went into shock. Electrocardiogram showed ST-segment elevation in the inferior leads; thus, an acute inferior myocardial infarction (MI) was strongly suspected. Emergent coronary angiography revealed subtotal right coronary artery (RCA) occlusion, and intravascular ultrasound showed flattening of the RCA ostium. Although the coronary artery flow improved after percutaneous coronary intervention with rescue stent implantation, the patient was still in a prolonged state of shock. Contrast-enhanced computed tomography revealed a ruptured thoracic aortic aneurysm (TAA) with a massive posterior mediastinal hematoma. We presumed that the acute MI and shock were caused by compression of the RCA ostium by the mediastinal hematoma and hemorrhage with TAA rupture, respectively. The patient was urgently transferred to another hospital for surgery. To the best of our knowledge, there has been no report on acute MI due to coronary artery compression by a mediastinal hematoma associated with TAA rupture. A staged therapeutic approach, involving preoperative coronary stent implantation, could be used to save the patient.