Myocardial infarction with huge mural thrombus due to spontaneous coronary artery dissection detected by 64-multidetector computed tomography

A 28-year-old man without medical history of cardiovascular disease came to the clinic to have the cause of his ECG abnormalities and chest discomfort evaluated. Echocardiogram showed regional wall motion abnormality of the anteroseptum and inferoseptum from the upper mid-left ventricle to apex with aneurysm and anterior wall from the mid-left ventricle to apex. It also showed huge and broad mural thrombus (5.2 × 1.4 cm in size) harboring in the left ventricle. Coronary angiography revealed a middle part of left anterior descending coronary artery (LAD) dissection with good distal flow. ECG gated 64-multidetector computed tomography (MDCT) demonstrated the proximal and middle part of LAD dissection. There has been no observation of myocardial infarction with huge mural thrombi complicating a spontaneous coronary artery dissection in which MDCT allowed an accurate and non-invasive diagnosis.