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Myocardial infarct (inferior)

Case contributed by: Dr Yi-Jin Kuok

Presentation:

Severe chest pain. ?aortic dissection

Patient Data:

Age: 78
Gender: Female
Race: Caucasian
Modality: CT

Images 74, 75, 76 demonstrate reduced first pass enhancement of the myocardial wall (posterior interventricular septum and posterior left ventricular wall). This has been outlined. 

Difficult appreciate these findings on these JPEG images. Soft tissue contrast improved on diagnostic panels/DICOM images.

No gross contour abnormality of the left ventricle (to indicate hypokinesis/akinesis)

No myocardial thinning in the hypoenhancing myocardium, suggesting that this is a relatively recent event.

Incidental multinodular goitre.

Case Discussion:

Initial ECG demonstrated minimal ST depression in the lateral leads (V4, V5 and V6).

Subsequent troponin came back at 20 IU/L.

Subsequent angiogram demonstrated TIMI II flow in the posterolateral branch (circumflex dominant circulation) which was stented.

Difficult to make this diagnosis on CT pulmonary angiogram which is usually done too early for uniform myocardial enhancement. Reserve this diagnosis for CT aortograms, which is typically done a few seconds later.

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