Excerpt

A 78-year-old male presented to his general practioner (GP) with upper abdominal pain existing for 2 weeks. An abdominal ultrasound demonstrated no upper abdominal pathology, but revealed a large pericardial effusion. The GP referred the patient immediately to the cardiologist. Cardiac examination revealed an anteroseptal/anterolateral wall myocardial infarction (MI) based on a culprit lesion in the left anterior descending artery. The subacute atypical presentation of this MI resulted in a complicated course as demonstrated by the transthoracic echocardiographic (TTE) and MRI images. TTE revealed anteroseptal and anterolateral wall motion abnormalities and an apical thrombus (Fig. 1a, d). MRI had clinically relevant complementary value by improving the visualization of the mechanical complications (Videos 1, 2). MRI revealed a contained rupture of the anterior wall of the left ventricle (Fig. 1b, c), apical thrombus (Fig. 1e,*), transmural infarction (Fig. 1c, e, f) and microvascular obstruction (Fig. 1e, f, arrow). In patients with a subacute presentation of myocardial infarction, MRI imaging can improve the visualization of complications and has to be considered in selected patients.

…