Images in Clinical Medicine

Cardiac Rupture

Andrew Redfern, F.R.C.S., F.R.C.R., and James Smart, F.R.C.R.

N Engl J Med 2003; 348:609February 13, 2003

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A 79-year-old man was admitted with atypical chest pain and electrocardiographic changes characteristic of an anterior myocardial infarction. The chest radiograph showed a widened mediastinum, raising the possibility of a thoracic aortic dissection. Therefore, before thrombolysis was instituted, dynamic computed tomography (CT) of the mediastinum was performed with the use of intravenous contrast material. During the procedure, the patient had an arrest due to electromechanical dissociation. The CT scan revealed cardiac tamponade with contrast in the pericardial cavity (thin arrows) and an area of myocardial rupture at the left ventricular apex (thick arrow). Needle pericardiocentesis did not improve the patient's condition, and an emergency open thoracotomy was carried out. The tamponade was drained, and the presence of a sizable rupture of the left ventricle was confirmed. Subsequent attempts at resuscitation were unsuccessful. Postmortem examination showed that the ventricular rupture had occurred through an area of full-thickness infarction.

Andrew Redfern, F.R.C.S., F.R.C.R.
James Smart, F.R.C.R.
Southampton General Hospital, Southampton SO16 6YD, United Kingdom

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