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Chest, GI

Left Ventricular Free Wall Rupture

History: 70 year old male with abdominal pain status post cholecystectomy

Left Ventricular Free Wall Rupture - Coronal CT of the abdomen and pelvis with intravenous contrast demonstrates an outpouching along the inferior wall of the heart (read arrows) which represents an acute contained left ventricular free wall rupture.

Left Ventricular Free Wall Rupture – Coronal CT of the abdomen and pelvis with intravenous contrast demonstrates an outpouching along the inferior wall of the heart (red arrows) which represents an acute contained left ventricular free wall rupture. The adjacent myocardium is not enhancing compatible with myocardial infarction.

This is a case of acute contained left ventricular free wall rupture diagnosed on a CT scan of the abdomen and pelvis obtained for abdominal pain. The patient had a myocardial infarction two days prior. The table below details the mechanical complications of myocardial infarction and when they occur most commonly.

Complications of Myocardial Infarction from: Contemporary Cardiology: Heart Disease Diagnosis and Therapy: A Practical Approach, Second Edition M. Gabriel Khan © Humana Press Inc., Totowa, NJ

Complications of Myocardial Infarction from: Contemporary Cardiology: Heart Disease Diagnosis and Therapy: A Practical Approach, Second Edition
M. Gabriel Khan © Humana Press Inc., Totowa, NJ

The main mechanical complications of myocardial infarction can be predicted based on the location of infarct, based on a study from the Journal of American College of Cardiology. See the tables below.

Mechanical complication rate based on myocardial infarction location from: Figueras, et al. JACC Vol. 32, No. 1. Jul 1998 135-9

Mechanical complication rate based on myocardial infarction location from: Figueras, et al. JACC Vol. 32, No. 1. Jul 1998 135-9

Mechanical complications based on which vessel involved in infarction from: Figueras, et al. JACC Vol. 32, No. 1. Jul 1998 135-9

Mechanical complications based on which vessel involved in infarction from: Figueras, et al. JACC Vol. 32, No. 1. Jul 1998 135-9

Heart Posterior left ventricle wall infarction

Heart Posterior left ventricle wall infarction (Photo credit: Wikipedia)

References:

1. Figueras, et al. JACC Vol. 32, No. 1. Jul 1998 135-9

2. Contemporary Cardiology: Heart Disease Diagnosis and Therapy: A Practical Approach, Second Edition
M. Gabriel Khan © Humana Press Inc., Totowa, NJ

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About radiologypics

I am a radiology physician from California, USA.

Discussion

3 thoughts on “Left Ventricular Free Wall Rupture

  1. Is it possible to have a mild MI on the upper left side of the chest? This started out gradually until I couldn’t bear the pain anymore so I went to the VA Urgent Care center after an hour and a half. The EKG was done, doc said nothing specific, and then placed into a room waiting for an hour for someone to see me, I was in so much pain radiating toward the upper back, my posterior left upper arm down to the elbow, and up the left side of my neck. CXR showed nothing, they did not do any blood work on me, dx was a pulled pec muscle from coughing so I was sent home still in pain. I did not feel good at all once I arrived home so I went to bed hoping that it would go away. Surprisingly, I woke up without any pain whatsoever, questioning how a pulled muscle with severe pain can disappear overnight!

    Patti

    Posted by patti | November 11, 2013, 10:26 am
  2. Hi Patti,

    Thanks for the comment. Its tough to diagnose what you had without seeing you in person, but I would venture to say its unlikely that you had an MI if you were discharged and the EKG was negative. Pulled muscle, maybe, maybe not. Another possibility is an entity called costochondritis, but that would not typically cause radiating pain down your arm. Sometimes (actually, frequently) the cause of pain is a mystery. In the end, I’m glad your pain went away!

    Dr. Koning

    Posted by radiologypics | January 7, 2014, 10:01 am

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