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Post myocardial infarction left ventricular free wall rupture diagnosed by multidetector computed tomography
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  1. R A Crossley,
  2. G J Morgan-Hughes,
  3. C A Roobottom
  1. robacrossley{at}hotmail.com

https://doi.org/10.1136/bcr.2006.094433

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    A 63-year-old man was admitted to an institution with symptoms and electrocardiogram signs consistent (central chest pain and inferior lead ST segment elevation) with inferior myocardial infarction. He had undergone immediate (paramedic administered) thrombolysis after a brief period of third-degree heart block and seemed to be recovering well.

    Approximately 24 h after admission (26 h after onset of chest pain) his condition deteriorated, with worsening chest and back pain associated with hypotension. Transthoracic echocardiography showed moderate left ventricular function. A chest x ray showed widened mediastinum. Given a past history of hypertension and plain film findings, non-electrocardiogram-gated multidetector computed tomography of the thorax was performed. The immediate findings were mediastinal blood to the level of the aortic arch, a pericardial effusion and a possible thrombosed aortic dissection flap at the level of the arch.

    At this time (48 h after admission), he was transferred to the Department of Clinical Radiology, Plymouth Hospital NHS Trust, Plymouth, UK. On arrival, transthoracic echocardiography showed moderately impaired left ventricular function (ejection fraction 40–45%), reasonable right ventricular function, normal mitral and aortic valve function, and 1.5 cm pericardial effusion. Sixty-four slice multidetector computed tomography (MDCT) was repeated and showed an inferior left ventricular rupture (panels A, B). Unfortunately, the patient’s condition deteriorated and he died after a pulseless electrical activity cardiorespiratory arrest.

    A review of the datasets from the original scan showed the extravasations of contrast from the inferior left ventricular wall. This shows that MDCT has a role in cases such as this: in this instance, proving superior to transthoracic echocardiography. It also serves to remind radiologists that with currently available technology intracardiac pathologies can be visualised only if they are considered.

    Acknowledgments

    This article is reproduced with permission from Crossley R A, Morgan-Hughes G J, Roobottom C A. Post myocardial infarction left ventricular free wall rupture diagnosed by multidetector computed tomography Heart 2007;93:06