First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
J Cardiovasc Comput Tomogr. 2011 Jan-Feb;5(1):63-5. doi: 10.1016/j.jcct.2010.09.004. Epub 2010 Sep 25.
We present the rare case of a 51-year-old man with acute myocardial infarction (AMI) caused by left main coronary artery (LMCA) occlusion due to intra-aortic thrombus. He arrived at our hospital with sudden left precordial oppression. Transcatheter coronary angiography for suspected AMI detected no coronary lesions. After 10 minutes, noncontrast computed tomography (CT) confirmed significantly high transmural attenuation areas suggesting myocardial infarction in the septal, anterior and lateral wall. Contrast-enhanced CT and transesophageal echocardiography detected a small mass near the ostium of the LMCA in the coronary sinus of Valsalva. We thus considered that the mass occluded the LMCA, which led to AMI. A stent was implanted to prevent the mass from sealing the LMCA ostium, but the patient died of sepsis. A post-mortem examination clarified that the mass was a red thrombus attached to an erosive and atherosclerotic aortic wall.
我们报告了一例罕见的病例，一名 51 岁男性因主动脉内血栓导致左主干冠状动脉（LMCA）闭塞引起急性心肌梗死（AMI）。他因突发左前胸压迫感而到我院就诊。疑似 AMI 的经导管冠状动脉造影未发现冠状动脉病变。10 分钟后，非增强计算机断层扫描（CT）证实了室间隔、前壁和侧壁的透壁高衰减区，提示心肌梗死。对比增强 CT 和经食管超声心动图在冠状动脉窦的瓦氏窦发现了靠近 LMCA 开口处的一个小肿块。因此，我们认为该肿块阻塞了 LMCA，导致 AMI。植入支架以防止肿块封闭 LMCA 开口，但患者死于败血症。尸检结果明确肿块是附着在侵蚀性和粥样硬化主动脉壁上的红色血栓。
