Left ventricular rupture
During the night, the patient collapsed, he lost his consciousness, and he had chest pain. ECG showed lateral STEMI, the patient was taken to the ER. When he arrived to the ER, he only had chest pain.
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On the non- contrast phase study we can see the there is around 15 mm thick pericardial fluid, which is slightly hyperdense. The aorta has a normal diameter, the wall is sclerotic. On the arterial phase, it is visible that the contrast material exits through the ruptured left ventricle into the pericardium.
Acute left ventricular rupture is a rare complication of myocardial infarction with high mortality. Nowadays, in the era of percutaneous coronary intervention and aggressive pharmacological therapy, the incidence of this complication massively decreased (~1%). Urgent surgery was needed and performed, but even so, the patient died.