PMC1395330_01
Myocardial contrast echocardiography images in the apical four-chamber view 3 beats after the high-mechanical index flash impulse (left panel) and 10 beats after the flash (right panel). The arrow shows the contrast extrusion from the left ventricular cavity into the myocardium in the lateral wall, before reaching the pericardial space, suggesting an impending rupture. LV = left ventricle; RV = right ventricle.
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F1
In addition, the presence of contrast extrusion from the left ventricular cavity into the myocardium could be observed, forming a serpiginous duct extending from the endocardium to the epicardial region of the lateral wall, without communication with the pericardial space (Figure 1).
Magnetic resonance imaging in the apical four-chamber view (A) and short axis view (B). The arrows points to the presence of contrast in myocardium similar to that seen by contrast echocardiography. LV = left ventricle; RV = right ventricle.
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F2
Magnetic resonance imaging demonstrated the same image of contrast extrusion into the myocardium (Figure 2), thus confirming the diagnosis.
Anatomical slice of the left ventricle obtained during necropsy. The infarction region is between the arrows. The big arrow shows the region of left ventricular free wall rupture. LV = left ventricle; RV = right ventricle.
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F3
Anatomopathologic findings were consistent with AMI in the lateral wall and a left ventricular free wall rupture at the infarct site (Figure 3), corresponding to the area seen by contrast echocardiography.