Myocardial infarction (aortic CTA)

Case contributed by Dr Francis Fortin

Presentation

Tearing chest pain radiating to the interscapular region. Elevated troponin level. Rule out aortic dissection.

Patient Data

Age: 70 years
Gender: Female

Aortic CT angiography (CTA)

CT

No evidence of acute aortic syndrome (non-contrast study not shown). However, despite the exam not being gated to the EKG, there is very likely full-thickness non-enhancement of the septal and anterior walls of the left ventricular myocardium.

Zoomed view

Annotated image

Zoomed view of a selected axial slice. The hypodense septal myocardium is marked in blue, whereas the normal density, enhancing myocardium of the lateral wall is marked in red.

Case Discussion

The emergency physician confirmed EKG changes and elevated troponin levels compatible with acute myocardial infarction

This case shows the importance of analyzing all parts of an exam in a systematic way, looking not only at what the clinicians request to rule in or out. Similarly, very few CT exams to rule out pulmonary embolism in Western countries are actually positive for pulmonary embolism, warranting a careful search for alternative pathology to explain patient symptoms.

Another important point is that, even on non-EKG-gated scans, several cardiac pathologies can be suggested.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.