Role of CT and MRI in Cardiac Emergencies

Figures

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  Figure 1. A young adult presenting at emergency department with acute chest pain, subtle ST alterations in the lateral wall of the left ventricle and cardiac enzymes elevation. Cardiac MRI was performed 48 h later demonstrating edema in the inferior-lateral wall of the left ventricle (a) associated with hyperemia in early gadolinium enhancement (b) and post-inflammatory fibrosis using late gadolinium enhancement sequences (c).

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  Figure 2. A 28 y/o man presented at the emergency department with fever and chest pain. At the admission, cardiac enzymes were elevated and ECG did not show any alteration. Cardiac MRI was performed 1 day later and revealed pericardial alteration: presence of edema (a) and post-inflammatory fibrosis (b,c).

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  Figure 3. MINOCA-Miocardial Infarct non obstructive coronaries. The patient presented to the emergency department with acute chest pain, ECG and cardiac enzymes suggestive of STEMI in the lateral wall of the left ventricle. The patient was readily referred to coronary angiography and cardiac catheterization showed absence of obstructive stenoses in the coronary tree (a). One day later a cardiac MRI was performed demonstrating a subacute ischemic scar in the lateral wall of the medium-apical left ventricle ((b)-LGE short axis view, (c)-LGE four chambers view). In the context of transmural late gadolinium enhancement, a constantly hypointense central area is present, representing a microvascular obstruction zone (red arrow). A cardiac CT was subsequently performed in order to assess coronary wall features and the presence of atherosclerosis. CT images in volume rendering (d) and multiplanar oblique reconstruction (e) demonstrated a non-calcified atherosclerotic alteration in an obtuse marginal vessel, serving the infarcted zone. A partly calcified atherosclerotic pathology was present in the anterior descending artery.

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  Figure 4. A 60 y/o woman presenting with acute chest pain and Troponin elevation with ECG alterations in the anterior leads. Echocardiogram showed dyskinesia of the anterior middle wall of the left ventricle. Subsequent cardiac MRI (24 h later) demonstrated dyskinetic movement in the anterior wall of the left ventricle ((a)-cine images frame in the systolic phase showing anterior bulging), associated to edema in the anterior wall (b). No LGE was found in the myocardial wall.

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  Figure 5. Acute Coronary Syndrome. A patient presenting to the emergency department with acute chest pain. No significant cardiac enzyme elevation and ECG alteration. Cardiac CTA shows absence of significant stenoses in the right coronary artery (a) and the left circumflex (b); a significant stenosis in the proximal anterior descending artery (c) is present, confirmed by subsequent coronary angiogram (d).

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  Figure 6. Patient with chest pain and dyspnea for more than 10 days with recent worsening of symptoms. CT shows the presence of massive bilateral pulmonary thrombo-embolism (red arrows) in the right and left lower lobe pulmonary artery (a). Secondary overload of the right-side circulation: enlargement of the right ventricle (c) and secondary tricuspid insufficiency (b).