A 55-year-old man was brought to the emergency room complaining of left-sided chest pain. His electrocardiogram was indeterminate, and a multidetector computed tomogram (MDCT) was performed to exclude aortic dissection. The patients aorta was normal, but an area of hypoperfusion was evident in the lateral ventricular myocardial wall. The ability to diagnose myocardial ischemia and infarcts on nongated MDCT is of particular clinical interest. As more imaging technology is devoted to imaging the heart, the greater expectations of radiologists ability to diagnose cardiac disease in the emergency room will become.
The development of multidetector technology has allowed production of computed tomographic images of the cardiovascular system that rival those obtained with invasive angiography. It now appears that paradigms regarding the evaluation of cardiovascular disease will change. Noninvasive techniques such as CT and MR will become the initial diagnostic examinations performed in the evaluation of cardiovascular system (CVS) disease while invasive techniques such as angiography will be reserved for therapeutic interventions such as angioplasty or stent graft placement. The ability to exclude or diagnose acute cardiac events in patients presenting to the emergency room will become a major reason for chest imaging. We present a case of acute myocardial infarction demonstrated on an ungated multidetector computed tomography (MDCT) study that was ordered to exclude aortic dissection.