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Left Ventricular Mural Thrombus-Atypical Myocardial Infarction Presenting With Upper Abdominal Pain and Vomiting: Imaging Diagnosis, Treatment, and Prognosis

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Executive Clinical Summary “Upper abdominal pain and vomiting.” When a patient presents to the emergency department with these symptoms, gastrointestinal disease is often considered first. However, particularly in older adults and patients with diabetes or cardiovascular risk factors, these symptoms may represent an atypical presentation of acute myocardial infarction. The key lesson from this case is not simply recognizing the symptoms. It is recognizing the clinical connection between myocardial infarction and the subsequent development of left ventricular mural thrombus (LVT) . A woman in her 70s with diabetes presented to the emergency department with a 3-day history of upper abdominal pain and vomiting. Electrocardiography demonstrated normal sinus rhythm with pathological Q waves and T-wave inversions in the precordial leads, while high-sensitivity troponin was elevated to 686 ng/L. Coronary angiography subsequently demonstrated complete occlusion of the mid left anterior descend...
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Endobronchial Blocker in Life-Threatening Hemoptysis: CT Angiography, Pulmonary Artery Pseudoaneurysm, and a Practical Imaging-to-Treatment Strategy

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Executive Clinical Summary A young patient with severe airway bleeding can deteriorate within minutes—not simply because of blood loss, but because blood and clots can obstruct the airways and contaminate the functioning lung. This principle becomes particularly important in life-threatening hemoptysis. The clinical case discussed here involves a 21-year-old man with septic shock and severe airway bleeding who had already undergone video-assisted thoracoscopic surgery (VATS) and intercostal catheter placement for empyema. Acute bleeding subsequently developed in the right upper lobe. Bronchoscopy localized the bleeding to the right upper lobe, while CT angiography demonstrated multiple pseudoaneurysms in the anterior portion of the right upper lobe. An endobronchial blocker was then placed to isolate the bleeding lobe. The case illustrates an important sequence in modern hemoptysis management: Bronchoscopy identifies where the blood is coming from. CT angiography identifies the vascula...
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