Blunt Cardiac Injury Resulting in Avulsion of Septal Myocardium Without Ventricular Septal Defect

Figures

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  Figure 1. TTE views (a) Modified apical four-chamber view shows a linear echodensity (yellow arrow) within the LV cavity, appearing to be attached to the myocardium. (b) Modified apical three-chamber view demonstrates no evidence of associated MR or VSD. (c) Focused apical four-chamber view with echo contrast confirms the absence of an apical thrombus. LV, left ventricular; MR, mitral regurgitation; TTE, transthoracic echocardiogram; VSD, ventricular septal defect

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  Figure 2. MRI findings on DWI and ADC sequences Axial cuts from DWI (left panel) and ADC (right panel) sequences demonstrate (a) hyperintensities on DWI with corresponding hypointense and some isointense areas on ADC in the cerebellar region (yellow arrows), (b) punctate foci of diffusion restriction at the level of the third ventricle, involving the left frontal territory (yellow arrow) and right occipital lobe (green arrow), along with evidence of a prior left craniotomy (yellow star), and (c) multiple areas of diffusion restriction at the level of the centrum semiovale, involving frontoparietal distributions. These findings indicate acute to subacute strokes in both anterior and posterior circulations, raising concern for a possible cardiogenic source of emboli. ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging

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  Figure 3. TEE views (a) Modified mid-esophageal, (b) transgastric long-axis, and (c) transgastric short-axis views of the LV cavity reveal a 17 × 8 mm segment of avulsed myocardium (yellow arrows) tethered by a stalk to the inferoseptal wall. Papillary muscle architecture appears preserved (green arrows). LV, left ventricular; TEE, transesophageal echocardiogram