CTICasesAcquired Ventricular Septal Defect (VSD) with Possible Pericardial Rupture Post-MI
[...]. Acquired Ventricular Septal Defect (VSD) with Possible Pericardial Rupture Post-MI. CTICases. Published September 30, 2016. https://str-case-explorer.pages.dev/c/d8a54
Imaging findings
CTA shows a dilated right ventricle and right atrium with straightening of the interventricular septum. Inferiorly, an acquired ventricular septal defect (VSD) is visible, caused by rupture related to a recent inferior myocardial infarction. A subtle contrast jet confirms left-to-right shunting. The VSD is notably close to the pericardium, raising suspicion for coexistent rupture into the pericardial space.
Key takeaways
In patients with a recent myocardial infarction and new onset heart failure or hypotension, always actively look for acquired VSDs and other mechanical complications. Right ventricular and right atrial dilation, along with septal straightening, should prompt a search for shunts. Concurrent pericardial rupture can lead to rapid hemodynamic compromise and acute demise.
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