Howick V James F, Korleski Jack, Brandt Michael D, Bilodeau-Gandre Jenna, Vardar Ufuk, Walkoff Lara A, Anavekar Nandan
Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC Case Rep. 2025 May 21;30(11):103302. doi: 10.1016/j.jaccas.2025.103302. Epub 2025 Mar 12.
Advances in computed tomography (CT) scanner technology and faster image acquisition have enabled improved visualization of cardiac structures, even on routine noncardiac chest CT scans. Recognition of incidental cardiac findings is crucial as they may signal underlying pathology. A 60-year-old woman with metastatic gastroesophageal junction cancer underwent outpatient surveillance CT which revealed decreased density of the left ventricular myocardium at the mid and apical anterior walls and septum, concerning for myocardial ischemia or infarction. Although asymptomatic and without cardiac history, she had markedly elevated troponin levels and was found to have an acute occlusion in the mid-left anterior descending artery, successfully treated with percutaneous coronary intervention. This case highlights the value of recognizing incidental myocardial hypoperfusion on noncardiovascular CT imaging. The literature describes hypoattenuation as a marker of acute myocardial infarction, but its detection in asymptomatic patients raises diagnostic and management challenges.
计算机断层扫描（CT）扫描仪技术的进步以及更快的图像采集，使得即使在常规非心脏胸部CT扫描中，心脏结构的可视化也得到了改善。识别偶然发现的心脏异常至关重要，因为它们可能预示着潜在的病理状况。一名60岁的转移性胃食管交界癌女性患者接受了门诊监测CT检查，结果显示左心室心肌在中前壁、心尖前壁和室间隔处密度降低，怀疑存在心肌缺血或梗死。尽管她没有症状且无心脏病史，但肌钙蛋白水平显著升高，经检查发现左前降支中段急性闭塞，随后通过经皮冠状动脉介入治疗成功解决。该病例凸显了在非心血管CT成像中识别偶然发现的心肌灌注不足的价值。文献将低密度影描述为急性心肌梗死的一个标志，但在无症状患者中检测到这种情况会带来诊断和管理方面的挑战。
