Adjuvant Role of CT in the Diagnosis of Post-Infarction Left Ventricular Free-Wall Rupture

Abstract

Left ventricular free wall rupture is usually a catastrophic mechanical complication of myocardial infarction. Risk factors include advanced age, female gender and absence of prior infarction. The vast majority of patients succumb rapidly due to cardiac tamponade and electromechanical dissociation. Expedited and accurate diagnosis can improve the chances of survival. Echocardiography has been advocated as the gold standard for diagnosis, but other imaging modalities can provide valuable information in these patients. We present the case of a patient who presented with cardiogenic shock, in which the definitive diagnosis of a left ventricular free wall rupture was accomplished by CT scan with intravenous contrast.

Keywords: Computed tomography; Myocardial infarction; Shock; Ventricular rupture.

Figure 1

ECG on presentation showing subtle ST segment elevation (arrow) and a deep-Q wave in AVL, along with marked ST segment depression in inferior leads.

Figure 2

Emergent bedside echocardiogram in the subcostal projection, showing the presence of a moderate pericardial effusion (E), along with clot (C) suggesting hemopericardium. RV: right ventricle; LV: left ventricle.

Figure 3

Left: Early images with a CT scan displaying a small rupture (arrow) in the posterolateral wall of the left ventricle with the presence of a hemopericardium, confirming the diagnosis of free wall rupture. Right: Delayed CT images (60 seconds after initial images) showing a small, hypodense area of infarction (arrow) in the inferolateral wall, with greater degree of contrast extravasation relative to the early images, suggesting active bleeding into the pericardial sac.