Fatal Left Ventricular Free Wall Rupture Complicating Acute Myopericarditis

Figures

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  Figure 1. Electrocardiograms Concave ST-segment elevation (arrows). Negative T waves on lateral leads (arrows).

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  Figure 2. Imaging at First Presentation (A) Pericardial effusion without hemodynamic compromise on echocardiography. (B) Normal mitral inflow velocities. (C) Low pericardial fluid density representing transudate, and small left pleural effusion on multidetector computed tomography angiography.

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  Figure 3. Echocardiography at Second Presentation (A) Large (20.5 mm) pericardial effusion. (B) Increased respiratory variation of mitral inflow velocity. (C) Plethora and reduced collapsibility of inferior vena cava.

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  Figure 4. Patient Echocardiography Upon Arrival to Our Hospital (A) Large pericardial effusion (yellow arrow). (B) Echogenic material inside the pericardial sac (red lines and asterisk). AV = aortic valve; LA = left atrium; LV = left ventricle; MV = mitral valve; PE = pericardial effusion; RA = right atrium; RV = right ventricle.

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  Figure 5. Multidetector Computed Tomography Angiography (A) Precontrast. Large hyperdense pericardial effusion with increased fluid density (>50 Hounsfield units), suggestive of hemopericardium. (B) Postcontrast during arterial phase. Contrast pooling in the posterolateral left ventricular (LV) wall corroborating free wall rupture (red arrow). (C) Active bleeding from LV wall to pericardial cavity (red arrow). (D) Coronal reformation postcontrast during arterial phase. Contrast outflow through the posterolateral LV wall (red arrow).

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  Figure 6. Postmortem Examination (A) Left ventricular free wall rupture. (B) A thick fibrinopurulent exudate layer covers the epicardium. Areas of hemorrhagic infiltration.

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  Figure 7. Histology Histologic examination of ventricular myocardial tissue (A) and rupture site (B).