This case demonstrates acute myocardial infarction with resulting perfusion deficits with microvascular obstruction. Invasive coronary angiography images confirmed the diagnosis.
Triple-Rule-Out computed tomography is useful for diagnosing or ruling out the major life-threatening thoracic pathologies: aortic dissection, pulmonary embolism and myocardial infarction. Especially since d-dimer levels can be elevated due to various other reasons as malignancies, infection or leucemia.
This patient presented with chest pain but also elevated d-dimer levels and shortness of breath. The treating cardiologist already suspected acute myocardial infarction, but requested a CT scan to also rule out pulmonary embolism. After diagnosis, the patient was immediately transferred to the cath lab and multiple stents were placed.
Microvascular obstruction, which is present in this case, is known to be a significant predictor of major adverse cardiac events. Unfortunately, this was also true in this case, as the patient deceased after a week from cardiac arrest.