Key result
A contrast-enhanced chest CT incidentally detected an acute inferolateral ST-elevation myocardial infarction in a 62-year-old burn patient whose initial electrocardiogram was nonischemic.
Why the study?
Myocardial infarction is typically diagnosed by ECG, but it can be incidentally detected on computed tomography, a finding that is rarely reported and not well characterized.
Case Report (n=1)
Computed tomography performed for trauma evaluation can incidentally identify myocardial hypoperfusion, allowing for the rapid and life-saving diagnosis of acute myocardial infarction in patients without typical presentations.
Incidental CT detection of myocardial hypoperfusion may prompt urgent ECG in atypical trauma cases; hypothesis-generating and requires prospective validation before practice change.
INTRODUCTION: ST-elevation myocardial infarctions (STEMI) represent complete occlusion of a coronary artery. An electrocardiogram (ECG) is a method of diagnosis; however, on rare occasions clues of myocardial infarction are first noted on imaging. This is a case of myocardial infarction first noted on computed tomography (CT). CASE REPORT: A 62-year-old man was brought to the emergency department after being found unresponsive with multiple burns. An ECG performed on arrival did not show changes consistent with myocardial ischemia. Due to reported trauma, a CT incidentally found a heterogeneous low-attenuation area in the posterior wall of the left ventricle of the heart. A repeat ECG subsequently showed an inferior STEMI. CONCLUSION: Computed tomography of the chest obtained in the evaluation of trauma may demonstrate evidence of myocardial ischemia. This case highlights the ability of CT to detect cardiac hypoperfusion. The role of CT in myocardial infarction diagnosis remains limited; however, given that the timing of contrast injection depends on the clinical question, it may not reliably assess the hypoperfusion.
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Araujo et al. (2026) conducted a case report in ST-elevation myocardial infarction (n=1). Contrast-enhanced computed tomography (CT) was evaluated. A contrast-enhanced chest CT incidentally detected an acute inferolateral ST-elevation myocardial infarction in a 62-year-old burn patient whose initial electrocardiogram was nonischemic.
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