Gotzmann Michael, Bojara Waldemar, Germing Alfried, Mügge Andreas, Laczkovics Axel, Thiessen Christine, Tannapfel Andrea, Lindstaedt Michael
Berufsgenossenschaftliche Universitätsklinik Bergmannsheil, Medizinische Klinik II,Kardiologie und Angiologie, Bürkle-de-la-Camp-Platz 1, Bochum, 44789, Germany.
BMJ Case Rep. 2009;2009:bcr0820080776. doi: 10.1136/bcr.08.2008.0776. Epub 2009 Mar 2.
A left main coronary artery (LMCA) stenosis without any atherosclerotic changes elsewhere in the coronary artery tree is a rare finding, and some uncommon reasons for luminal narrowing should be considered. An unusual case of non-atherosclerotic LMCA stenosis is reported.A middle-aged patient presented with acute myocardial infarction. An immediate coronary angiography was ordered and revealed a subtotal mid LMCA stenosis. A drug-eluting stent was successfully implanted in the LMCA.Operative revascularisation was recommended. Routine surgery was performed and surprisingly revealed an extended mass of a mediastinal tumour surrounding the aortic root. Histopathological examination of the tumour revealed a poorly differentiated squamous cell carcinoma.Postoperatively, the patient was treated with chemotherapy (carboplatin and docetaxel). Five years after the first admission to our hospital, the patient died as a result of ventricular fibrillation.The differential diagnosis of non-atherosclerotic LMCA stenoses is discussed.
左主干冠状动脉（LMCA）狭窄而冠状动脉树其他部位无任何动脉粥样硬化改变是一种罕见的发现，应考虑一些导致管腔狭窄的 uncommon 原因。本文报告了一例非动脉粥样硬化性LMCA狭窄的 unusual 病例。一名中年患者出现急性心肌梗死。立即进行冠状动脉造影，显示LMCA中段次全狭窄。一枚药物洗脱支架成功植入LMCA。建议进行手术血运重建。进行了常规手术，令人惊讶的是发现主动脉根部周围有一个纵隔肿瘤的扩展肿块。肿瘤的组织病理学检查显示为低分化鳞状细胞癌。术后，患者接受了化疗（卡铂和多西他赛）。首次入住我院五年后，患者因心室颤动死亡。本文讨论了非动脉粥样硬化性LMCA狭窄的鉴别诊断。
