Left ventricular rupture

Case contributed by Stefan Tigges

Presentation

3 days of "indigestion". His head, neck, shoulders, and arms are swollen and purple.

Patient Data

Age: 50 years
Gender: Male
X-ray

Portable CXR shows pulmonary hypoinflation, but no edema or pneumonia. The cardiomediastinal silhouette is grossly normal.

CT

Chest CT angiogram shows a dense pericardial effusion, likely a hemopericardium, compressing the right ventricle. There is a blood/contrast level in both the superior and inferior vena cavae. The thoracic aorta is normal in course and caliber with no dissection.

Annotated intraop photo

Photo

An intraoperative photograph shows a jet of blood (dashed green circle) exiting a defect in the lateral left ventricular myocardium.

Intraoperative movie

Photo

Intraoperative movie loop confirms a left ventricular defect with active bleeding.

Intraoperative movie

Photo

Intraoperative movie loop confirms successful repair of a left ventricular defect.

Case Discussion

This patient presented with a 3-day history of "indigestion", which was due to a lateral left ventricular wall myocardial infarction. At presentation, he was dyspneic and his head, neck, shoulders, and arms were swollen and purple. A CT angiogram of the chest was obtained to rule out aortic dissection after an echocardiogram showed a pericardial effusion. The CT confirmed a dense pericardial effusion, suspicious for hemopericardium. Causes for hemopericardium include rupture of a type A dissection into the pericardium, rupture of a coronary artery aneurysm, and left ventricular rupture following myocardial infarction. The blood/contrast level in the SVC/IVC is a grave prognostic sign indicating severe compromise in the flow of blood into and through the heart. Compression of the right ventricle confirms impaired cardiac filling/diastole. The intraoperative photograph and movie loop shows a jet of blood exiting the ruptured lateral wall of the left ventricle. The defect was successfully repaired.

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