case_images: PMC2734919_01
case_images: Initially, the coronary angiography showed an acute thrombotic occlusion on the second segment of the right coronary artery (Panel (a)). The patient underwent angioplasty and stenting with a final good result (Panel (b)). Coronary angiography revealed a severe stenosis on a minor circumflex coronary artery (Panel (c)). There were many diffuse lesions on the left anterior descending coronary artery and his branches without significant stenosis (Panel (d)).
case_images: CRM2009-370542.001.jpg
case_images: PMC2734919_01_CRM2009-370542.001.jpg
case_images: fig1
case_images: Emergency coronary angiography revealed an acute thrombotic occlusion of the second segment of the right coronary artery, a severe stenosis of a non-dominant and small circumflex coronary artery and diffuse plaques in all segments of the left anterior descending coronary artery (Figure 1, Panel (c) and (d)); the patient underwent angioplasty and (bare metal) stenting with a good final result (Figure 1, Panel (a) and (b)).
case_images: Black blood T2 images (T2 weighted short inversion-time, inversion-recovery (STIR) breath hold pulse sequences) suggested myocardial oedema (arrowheads) strictly in the inferior wall (Figure 2, Panel (e)). Gadolinium-enhanced images (Inversion Recovery turboFLASH 3D short axis and long axis sequences) demonstrated transmural late enhancement of the inferior wall (arrowheads) associated with late microvascular obstruction (Panel (f) and (g)). Furthermore, these sequences showed a subendocardial delayed enhancement area (arrows) which was located in the anterior wall at mid-ventricular level in favour of a limited necrosis (Panel (f) and (g)). Myocardial perfusion scintigraphy with thallium-201 suggested hypoperfusion in the inferior and lateral walls during stress but did not detect at rest any hypouptake in the anterior wall (Panel (h)).
case_images: CRM2009-370542.002.jpg
case_images: PMC2734919_01_CRM2009-370542.002.jpg
case_images: fig2
case_images: Black blood T2 images (T2 weighted short inversion-time, inversion-recovery (STIR) breath hold pulse sequences) suggested myocardial oedema in the inferior wall (Figure 2, Panel (e)). CMR detected transmural delayed enhancement in the inferior wall associated with late microvascular obstruction 10 minutes after gadolinium injection (Figure 2, Panel (f) and (g)). Myocardial scintigraphy suggested myocardial ischaemia in the inferior, lateral and basal walls in favour of a restenosis, but this study did not detect any myocardial necrosis in the anterior wall (Figure 2, Panel (h)).