A 65-year-old patient who was complaining of dyspnoea and chest pain with dorsal irradiation was admitted for suspicion of aortic dissection. Electrocardiography showed Q waves on lateral leads; transthoracic echocardiography showed pericardial blood effusion and akinetic lateral wall motion. Contrast-enhanced electrocardiogram-gated acquisition using dual-source multidetector computed tomography ruled out aortic dissection and showed a perfusion defect of the left ventricle ( Fig. 1 A ), associated with two intramyocardial ruptures (arrows) and pericardial effusion (asterix). Further reconstructions evidenced a complete cleft-like transmural rupture of the left ventricular wall ( Fig. 1B ), and three-dimensional imaging ( Fig. 1C ) confirmed occlusion of a left marginal coronary artery (black arrowheads), responsible for myocardial infarction, with two intramyocardial ruptures (white arrows). The patient was immediately sent to the operating room, without coronary angiography. Two slit-like transmural ruptures of the lateral left ventricular wall were confirmed ( Fig. 1D ) (white arrows) and were treated successfully with a pericardial patch. The patient was discharged at day 10.
