Chronic Myocardial Infarction, Chronic MI

Description: This series of CT image shows a faint curvilinear lucency in the apical myocardium (a,b) as well as myocardial calcification. The lucency is thought to be a fatty deposition in infarcted myocardial tissue, and the calcification represents dystrophic calcification in the necrotic tissue. Included in the differential diagnosis is an apical aneurysm with calcification in clot. The calcification in the annulus is premature and unusual for this 56 year old male patient. Note the small bilateral pleural effusions. . 29601c code CVS cardiac heart MAC apical fat MI calcium myocardium apex cardiac imaging radiology CTscan


Description: This series of non contrast CT scans through the inferior aspect of the LV shows a thin lucency of fat density which is located on the endocardial side of the myocardium. This suggests that there is significant associated thinning of the myocardium. There are a few punctate dystrophic calcifications in the septal component of the lucency. (a,b) The lucent abnormality also extends to the apex and the free wall of the LV. In images c and d the apex bulges forming an apical aneurysm. The findings are consistent with previous infarction with fatty changes in the infarcted region. . 38325c code cardiac heart LV apex septum free wall lucent fat calcification MI aneurysm CAD IHD imaging radiology CTscan

CT scan of a 67 year old female with anca positive vasculitis shows of dystrophic calcification in the lateral aspect of the right lower lobe (white arrow, a and b) )with focal nodular parenchymal consolidation, that likely reflects a site of prior small vessel infarct. Dystrophic calcification in the LV myocardium (blue arrows c) and a suggestion of fatty dysplasia in the left ventricular apex red arrow d) suggest changes from small vessel infarct.

Ashley Davidoff MD


Enlarged Left Ventricle   What is the cause of the cardiomegaly? The CT scan is from a 76 year old man in whom the dominant finding is of left ventricular enlargement, characterized by the rotund shape of the ventricle and the increased dimension. The RA and RV are also enlarged based on this image, and LA was enlarged as well suggesting global cardiomegaly consistent with a cardiomyopathy. The clue to the cause of the enlargement is the segmental nature of the disease, characterized by the asymmetry thickness when the free wall thickness is compared to that of the thinning of the septum. In addition, the presence of fat (yellow overlay) in the thinned and probably scarred myocardium, makes ischemic cardiomyopathy the likely diagnosis.
Courtesy of: Ashley Davidoff, M.D  heart-anatomy-P-047
Normal Size of the Right Ventricle and Left Ventricle in the Axial projection During Diastole    The axial gated CT scan through the right and left ventricle at end diastole shows the normal size and shape of the right ventricular inflow tract and left ventricle. The right ventricular inflow (underlying the RV measurement)  looks smaller than the LV in volume, in this view, since essentially it makes up for the volume in its second “floor” which sits more cranially as the right ventricular outflow tract. The left ventricle only has a single level or floor. Thus in this view the RV looks and measures smaller then the LV. Note also that the apex of the left ventricle protrudes slightly more anteriorly than the RV even though it is the posterior ventricle, because it is the chamber that forms the apex of the heart. The septum also bulges toward the right ventricle due to the higher pressure in the left ventricle.
Courtesy of: Ashley Davidoff, MD
aka 37758b01c01.8s
aka heart anatomy P 040