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This is an interesting case of a 56-year-old man

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who comes into the ER presenting with generalized pain and malaise.

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He felt like the pain was much more

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pronounced in his abdomen and he hadn't had a bowel movement for three days.

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He ended up getting a CT abdomen and pelvis with contrast.

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And although this is a chest section,

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there is a pertinent finding that we want to discuss here.

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And so really, this is a reminder that on your abdominal

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exams, you will have information that's sitting in the chest and to be very,

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very attuned to looking at images and findings that are at the edge of film.

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And so on this examination,

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on the axial images with contrast, through the portion of the chest,

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as we scroll in one or two in, what we begin to see is that there is

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a rim of hypoattenuation of the myocardium here that continues on a number of slices.

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And you can see here it involves the apex

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and the interventricular septum, and it's quite pronounced.

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So when we looked at this, we certainly made note of it.

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We continued through the exam, and just

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to go through really quickly, he does have quite a bit of stool

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that would explain, you know, he hasn't had a bowel movement for three days.

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He's feeling a little bit of discomfort and distention.

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But we brought it back to the finding at the edge of the film and we called

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the clinicians and said, 'Hey, this is really interesting.

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This guy looks like he's had a myocardial infarction.

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He's got myocardium that's not enhancing on contrast exam.

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Has he had an EKG?

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Does he have troponins that were sent?'

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And they hadn't been thinking about that because of the non specific pain.

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He didn't have a characteristic arm pain radiating to the jaw.

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He wasn't having chest pain,

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but they did troponins, they did EKG, he did have changes and he was positive.

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And this is an example of an acute myocardial infarction on CT.

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It's also a reminder to look at the periphery,

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to look at the last image, the first image,

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and everything in between, because there's going to be data there.

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And if you don't look at it, you won't see it.

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Just as a comparison, you can see the rim of hypoattenuating

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myocardium here on the sagittal view and on the coronal,

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again, you see it in this area right here.

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So this is the case of myocardial infarction,

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incidentally noted on a CT abdomen and pelvis with contrast.

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But remember that there are chest images there,

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and this is a patient who may not have had

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typical chest pain but had a general malaise.