Contrast Pooling and Layering in a Patient with Left Main Coronary Artery Occlusion and Cardiogenic Shock.
A 57-year-old male with type 2 diabetes mellitus presented to the emergency department with sudden onset of chest pain. Shock status and considerably low right arm blood pressure were detected. The patient underwent contrast-enhanced computed tomography (CT) which revealed dependent contrast pooling and layering of contrast material within the inferior vena cava. Post-processing CT angiography depicted total occlusion of the left main coronary artery. Sudden cardiac arrest developed after CT examination, and following emergency coronary angiography we confirmed the diagnosis of left main coronary artery occlusion and cardiogenic shock. Clinical physicians should recognize these CT findings of imminent cardiovascular decompensation and provide prompt medical management to prevent further patient deterioration.


BACKGROUND
Cardiogenic shock; Dependent pooling; Layering; Left main coronary artery disease.
Division of Cardiology, Department of Medicine;
Tzu-Chiao
TC
Lin
Division of Cardiology, Department of Medicine;
Chin-Sheng
CS
Lin
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Hsian-He
HH
Hsu
Division of Cardiology, Department of Medicine;
Jun-Ting
JT
Liou