Discrepancy between coronary angiography and autopsy finding

Area of Science:

• Cardiology
• Nephrology
• Critical Care Medicine

Background:

• Septic shock can lead to multi-organ dysfunction, including acute kidney injury.
• Myocardial infarction is a concern in critically ill patients, necessitating diagnostic evaluation.
• Contrast-induced nephropathy is a risk in patients with renal impairment.

Observation:

• A 71-year-old man presented with septic shock and acute renal failure.
• Coronary cineangiography was performed to rule out myocardial infarction, using minimal contrast to prevent nephropathy.
• Angiography revealed no significant coronary lesions.

Findings:

• Autopsy demonstrated severe stenosis in the coronary arteries.
• There was a discrepancy between angiographic findings and post-mortem examination.
• The patient's septic shock and acute renal failure may have influenced diagnostic accuracy.

Implications:

• This case underscores the potential for false-negative results in coronary angiography in critically ill patients with renal compromise.
• It emphasizes the importance of considering autopsy findings in understanding diagnostic limitations.
• Further research may be needed to optimize cardiac evaluation in septic shock patients with acute kidney injury.