Post-infarction Left Ventricular Free Wall Rupture Diagnosed by Contrast-Enhanced Computed Tomography: A Case Report

Abstract

A 70-year-old Japanese woman with hypertension, dyslipidemia, and diabetes mellitus complained of abdominal discomfort and vomiting and was brought to our emergency department by ambulance two days later with impaired consciousness. Her vital signs suggested shock with a heart rate of 120 bpm. Electrocardiogram and initial transthoracic echocardiography suggested an inferior wall ST-elevation myocardial infarction, but the altered consciousness was inconsistent. Contrast-enhanced computed tomography was urgently performed to further clarify the cause. It revealed pericardial effusion and apparent extravasation from the left ventricular wall, confirming the early definitive diagnosis of left ventricular free wall rupture. The patient underwent successful emergent surgical repair without sequelae. Differential diagnosis of left ventricular free wall rupture is important in patients with ST-elevation myocardial infarction and impaired consciousness. Contrast-enhanced computed tomography allows early diagnosis and treatment of this life-threatening complication.

Keywords: contrast-enhanced computed tomography; echocardiography; impaired consciousness; left ventricular free wall rupture; st-segment elevation myocardial infarction.

Figure 1. Electrocardiogram showed sinus tachycardia and ST-segment elevations in inferior leads, including II, III, aVF, and ST-segment depression in anterior leads V1-V4.

Figure 2. Contrast-enhanced computed tomography (CECT) imaging shows effusion from the left ventricle into the pericardial space (arrow) and pericardial effusion (arrowheads).

Figure 3. Transthoracic echocardiogram after the contrast-enhanced computed tomography (CECT) shows 13-mm pericardial effusion (asterisk).

LV; left ventricle, RV; right ventricle.