Acute subepicardial infarction associated with severe septic shock--insight in myocardial perfusion.
Isolated infarctions of the subepicardial myocardium without changes in subendocardium are extremely rare. We present an autoptic case with an acute subepicardial infarction of the right- and left-ventricular myocardium. A 53-year-old male was admitted to hospital with acute upper abdominal pain. Clinical examination revealed an acute infero-lateral myocardial infarction. The patient succumbed to acute heart failure a few hours later. Autopsy revealed numerous pulmonary abscesses due to suppurative lobular pneumonia with consecutive pericardial effusion. Furthermore, we diagnosed an acute myocardial infarct encompassing the entire right and left ventricles but limited to the subepicardial myocardium only. Microscopically, we observed fibrin microemboli in the subepicardial microvessels. The existence of an isolated subepicardial myocardial infarct challenges our understanding of myocardial perfusion.
May
Annette M
AM
Department of Pathology, University of Freiburg, Breisacher Strasse 115a, D-79106 Freiburg i.Br., Germany.
Riede
Florian N
FN
Riede
Ursus-Nikolaus
UN
D001011:Aorta / Q000601:surgery; D003331:Coronary Vessels; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D017809:Fatal Outcome; D006801:Humans; D006973:Hypertension / Q000150:complications; D007925:Leriche Syndrome / Q000601:surgery; D008169:Lung Abscess / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D010998:Pleurisy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011014:Pneumonia / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D012772:Shock, Septic / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D013290:Streptococcal Infections / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D034367:Streptococcus intermedius