Special Cases Stabbing Chest Pain Case history/ Imaging data

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• 18-year-old male
• Height: 6 feet
• Weight: 180 pounds
• This patient arrived to the ER with knife wound to the chest. No pulse and BP could be detected, ECG showed a few complexes per minute. Cardiac tamponade was suspected and acute thoracotomy was performed. A large amount of blood was indeed found in the pericardium. No lesion could be seen in the right ventricule, which was the expected finding.
  Howewer, slow pulsating bleeding was seen coming from LAD, which had been severed proximally, and there was a superficial lesion in the left ventricular myocardium. A clamp was quickly put on the upper LAD end, and the patient transfused. The present myocardial perfusion study was performed 1 1/2 week later.
• Evaluate for ischemia

SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi. Images representing myocardial perfusion were obtained at rest and peak stress.

Stress protocol	Std.Dobutamine
Duration of stress	12 min
Peak heart rate (85%)	83 --> 130 (85%=172)
Systolic BP (basal --> peak)	120 --> 145
Double product (peak rate x BP)	18,850
Reason for termination	Palpitation, refusal to continue. No chest pain
ECG findings	1 mm ST depression

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IMAGES	FINDINGS	IMPRESSION	(TUTORIAL)
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Atlas of Myocardial Perfusion SPECT
© Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

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Initiated: Nov 19, 1995. Last updated: April 26, 1999.