Acute Left Anterior Descending Occlusion Myocardial Infarction Incidentally Found on Surveillance Computed Tomography

Advances in computed tomography (CT) scanner technology and faster image acquisition have enabled improved visualization of cardiac structures, even on routine noncardiac chest CT scans. Recognition of incidental cardiac findings is crucial as they may signal underlying pathology. A 60-year-old woman with metastatic gastroesophageal junction cancer underwent outpatient surveillance CT which revealed decreased density of the left ventricular myocardium at the mid and apical anterior walls and septum, concerning for myocardial ischemia or infarction. Although asymptomatic and without cardiac history, she had markedly elevated troponin levels and was found to have an acute occlusion in the mid-left anterior descending artery, successfully treated with percutaneous coronary intervention. This case highlights the value of recognizing incidental myocardial hypoperfusion on noncardiovascular CT imaging. The literature describes hypoattenuation as a marker of acute myocardial infarction, but its detection in asymptomatic patients raises diagnostic and management challenges.