PMC6276461_01
Signs and consequences of ventricular septal rupture due to acute myocardial infarction. (a) ECG. ST-segment elevation in leads II, III, aVF, and V6. (b) to (e): Computed tomography. (b) Transverse plane. Acute inferior myocardial infarction (black arrowheads) and ventricular septal rupture (black arrow), both associated with dilation of the right ventricle and retrograde flow of contrast agent into the liver veins due to acute right heart failure. (c) Sagittal plane. Ventricular septal rupture (black arrow) due to acute myocardial infarction with extensive microvascular obstruction (red arrowheads). (d) Transverse plane, arterial phase after intravenous injection of contrast agent. Contrast is seen in renal and hepatic veins as a sign of severe venous congestion. (e) Sagittal oblique plane, late phase after injection of contrast agent. Hepatic veins, hepatic parenchyma, and the portal vein (yellow arrow) are still opacified due to backward failure of the right heart.
CRICC2018-1568491.001.jpg
PMC6276461_01_CRICC2018-1568491.001.jpg
fig1
ECG showed ST-segment elevation in leads II, III, aVF, and V6 (Figure 1). Type-A-dissection would have prompted emergency surgery, the heart team decided for immediate computed tomography (CT), which showed no signs of Type A aortic dissection, pulmonary embolism, intracerebral bleeding, or carotid stenosis, but severe ubiquitous aortic calcification. Main findings were as follows: a large ventricular septal rupture with classical radiological signs of acute myocardial infarction (Figure 1), signs of severe backward failure with contrast agent being observed in hepatic veins, renal veins (Figure 1), the portal vein and the inferior vena cava (Figure 1), and thrombotic occlusion of the descending aorta just distal to the left subclavian artery (Figure 2). The latter was probably facilitated by massive left-to-right shunt and associated severe forward failure.
Acute aortic occlusion. Computed tomography. (a) Sagittal plane, arterial phase after intravenous injection of contrast agent. The descending aorta is not filled with contrast (circle 1: 70 HU, circle 2: 73 HU). Note the severe calcification of the aorta. (b) Sagittal plane, late phase after intravenous injection of contrast. While few contrast enters the proximal part of the thrombus (apposition zone, circle 3: 105 HU), it does not reach the already more solid parts of the thrombus (circle 4: 78 HU). HU: Hounsfield Units.
CRICC2018-1568491.002.jpg
PMC6276461_01_CRICC2018-1568491.002.jpg
fig2
Type-A-dissection would have prompted emergency surgery, the heart team decided for immediate computed tomography (CT), which showed no signs of Type A aortic dissection, pulmonary embolism, intracerebral bleeding, or carotid stenosis, but severe ubiquitous aortic calcification. Main findings were as follows: a large ventricular septal rupture with classical radiological signs of acute myocardial infarction (Figure 1), signs of severe backward failure with contrast agent being observed in hepatic veins, renal veins (Figure 1), the portal vein and the inferior vena cava (Figure 1), and thrombotic occlusion of the descending aorta just distal to the left subclavian artery (Figure 2). The latter was probably facilitated by massive left-to-right shunt and associated severe forward failure.