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Contained ventricular free wall rupture without pericardial effusion: a diagnostic challenge in acute myocardial infarction

Year: 2025

Type: article

Abstract: Background Left ventricular free wall rupture is a rare but often fatal complication of acute myocardial infarction (MI). While typically associated with pericardial effusion and tamponade, left ventricular free wall rupture can occasionally present as a contained rupture, leading to diagnostic delays. Case summary A 69-year-old woman with prior mitral and tricuspid valve repair and atrial flutter treated with apixaban presented with cardiogenic shock following a posterior ST-elevation MI. Coronary angiography revealed thrombus in the right coronary artery and thrombotic occlusion of the left circumflex artery (LCx)- obtuse marginal (OM) branch. During evaluation for mechanical support, echocardiography suggested a large left ventricular mass. Further imaging raised suspicion of an intramural hematoma without pericardial effusion. Surgical exploration confirmed a sealed ventricular rupture contained by the parietal pericardium. Despite timely intervention, the patient succumbed to her condition. Discussion This case emphasizes the diagnostic challenge posed by left ventricular free wall rupture without pericardial effusion. High clinical suspicion, even in atypical presentations, and rapid multidisciplinary management are critical for improved outcomes.

Source: Cardiovascular Revascularization Medicine Interesting Cases

DOI: 10.1016/j.crmic.2025.100099

Authors: Ranin Hilu, Yoram Neuman, Abid Assali, Hana Vaknin Assa

Institutions: Tel Aviv University, Meir Medical Center

Language: English

Topic: Cardiac Structural Anomalies and Repair

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $920