Dual SPECT Imaging With Tc-99m Pyrophosphate and Tl-201 of Circumferential Subendocardial Myocardial Infarction in Aortic Stenosis Without Coronary Artery Stenosis

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An 88-year-old woman with aortic stenosis, who had demonstrated fever for several preceding days, complained of angina and orthopnea. Although the symptoms were suggestive of acute myocardial infarction, coronary angiography failed to demonstrate coronary artery stenosis. Dual SPECT with Tc-99m pyrophosphate and Tl-201 demonstrated an abnormal accumulation of the former tracer throughout the inner layers of the left ventricle, indicating circumferential subendocardial infarction. Confirmation of this diagnosis is often difficult, and there have been only a few documented cases. However, the present images clearly depicted this unusual view of infarction in a patient with aortic stenosis but without coronary artery stenosis.

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