Left ventriculography for posterolateral free wall rupture complicated with ST-elevated myocardial infarction

Left ventricular free wall rupture is not a rare complication of ST-elevated myocardial infarction, and causes fatal results. This complication is often diagnosed on the basis of hemodynamic collapse and transthoracic echocardiography. We describe a case of posterolateral free wall rupture that could not be diagnosed using transthoracic echocardiography but was diagnosed using left ventriculography, mainly in the left anterior oblique view. We were unsuccessful in preventing patient fatality because of late diagnosis. Therefore, we must keep in mind the limitation of each diagnostic modality. <Learning objective: A posterior wall rupture sometimes shows no pericardial effusion on transthoracic echocardiography. Left ventriculography may be a useful modality as a last resort to detect posterior wall rupture. In this situation, the right anterior oblique view may not demonstrate the contrast extravasation of a posterior wall rupture, and the left anterior oblique view may be useful in detecting it.>.