CTICasesAcute Coronary Syndrome with Post-Operative Myocardial Infarction
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Imaging findings
Dependent consolidation and striking features of edema, including subpleural edema with visceral thickening and extensive septal thickening (both interstitial and alveolar edema). There was hypoenhancement of the subendocardium in both the LED territory and the lateral wall, along with severe three-vessel calcification. Delayed CT showed decreased subendocardial and some transmural enhancement throughout the left ventricle, confirming an acute coronary syndrome.
Key takeaways
It is crucial to actively look for signs of myocardial infarction in post-operative patients presenting with hypotension and pulmonary edema, even if initial troponins are only moderately elevated and clinicians initially suspect sepsis or pneumonia. Cardiac CT findings, such as perfusion abnormalities and delayed enhancement, can help distinguish cardiac ischemia from infection and guide appropriate management.
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