CTICasesPost-Myocardial Infarction Right Ventricular Rupture with VSD and Hemopericardium
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Imaging findings
A patient presented with severe chest pain, elevated troponin, and shock, treated for presumed STEMI. CT revealed high-density pericardial effusion (hemopericardium) and abnormal mixing of contrast across the inferior aspect of the ventricular septum. Coronary angiography showed a completely occluded right coronary artery. Echocardiography confirmed a ventricular septal defect (VSD) in the inferior wall, everting into the hemopericardium. Emergency surgery found rupture of the inferior wall of the right ventricle and a VSD through the inferior wall to the left.
Key takeaways
This dramatic case illustrates a severe post-myocardial infarction complication involving both right ventricular free wall rupture and a ventricular septal defect (VSD) through the inferior wall, leading to hemopericardium, following occlusion of the right coronary artery. This combination of events is highly morbid but the patient made a remarkable recovery.
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