Acute myocardial infarction in CT

Case contributed by Dr Sebastian Tschauner

Presentation

The patient collapsed at the medical office of her general practitioner after a sudden onset of severe epigastric pain and breathlessness. Her head was injured after falling and the emergency doctor had to resuscitate her for more than one hour. When arriving at the hospital, polytrauma CT was requested, because of skull trauma and suspected spinal injuries.

Patient Data

Age: 40 years
Gender: Female

AP chest radiograph in the emergency trauma room

Bilateral opacities are seen predominantly in the upper lung parts, consistent with pulmonary edema.

No pneumothorax. No pleural effusions.  Mediastinum normal.

Endotracheal intubation.

Myocardial hypoperfusion can be seen in left anterior descending artery (LAD) perfusion bed.

Pulmonary edema in the upper lobes and dystelectasis in both lower lobes.

No relevant pathologies in abdomen or pelvis.

Anterior rib fracture on the left side after resuscitation.

Myocardial hypoperfusion in LAD perfusion bed

With adjusted window settings, hypoperfusion in Left Anterior Descending Artery (LAD) perfusion bed is very well depicted in portal venous contrast phase of the abdominal slices (heart partially shown).

The consecutive myocardial infarction had caused the patient's fall.

Case Discussion

Acute myocardial infarction may in some cases be depicted very well in contrast-enhanced CT.

In this patient, missing contrast enhancement in the service area of the left anterior descending (LAD) coronary artery was diagnosed, best seen in portal venous contrast phase of the abdominal slices.
She was transferred to cardiac catheterization immediately after this examination.

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