Myocardial infarction without coronary artery stenosis illustrated by Tc-99m pyrophosphate scan, cardiac magnetic resonance imaging, and myocardial perfusion scintigraphy.
A 42-year-old woman presented with chest pain and ECG changes suggestive of acute myocardial infarction. However, a coronary angiogram showed no significant epicardial coronary stenosis. Nonetheless, abnormal Tc-99m pyrophosphate activity accumulated within the inferolateral wall, consistent with acute necrosis. Cardiac magnetic resonance revealed near transmural extent of late gadolinium-enhancement with mild hypokinesis in the mid to basal inferolateral segments. Dipyridamole Tl-201 single photon emission computed tomography 6 months later demonstrated stress-induced ischemia in the corresponding area, with subendocardial scar in the mid level. Nuclear perfusion scintigraphy is needed for accurate assessment of infarct size and coronary flow after the acute stage of a myocardial infarction has passed.
Cheng
Mei-Fang
MF
Division of Nuclear Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Taiwan.
Lin
Yen-Hung
YH
Tseng
Wen-Yih I
WY
Wu
Yen-Wen
YW
D000328:Adult; D003287:Contrast Media; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D016698:Technetium Tc 99m Pyrophosphate; D014463:Ultrasonography
D003287:Contrast Media; D016698:Technetium Tc 99m Pyrophosphate