Would your radiologist make this diagnosis, or should you record an ECG in trauma?

A very young man had severe blunt trauma with severe head injury.As part of his evaluation, he had a " pan-scan " which of course includes a chest abdomen pelvis CT.Here is one slice of his chest:What do you see?Let ' s look at a closer view, and also made easier to see using Spectral CT:And one more:The very dark area at the septum and the apex of both ventricles is transmural ischemia.  There is no contrast making it into this area which should be perfused by the LAD.Here is a color image of the same:Notice the extremely dark area at the apex and apical part of the septum.The radiologist was Dr. Gopal Punjabi, who is quite a wizard, and frequently diagnoses acute MI on CT scan of the chest.  He immediately saw this and notified the clinicians.Because of this CT interpretation, they recorded an ECG:It is clear that this transmural ischemia (STEMI/OMI) could have been diagnosed earlier with an ECG.The ECG is all but diagnostic of LAD occlusion (Occlusion MI, or OMI)This is almost certainly due to LAD Occlusion MI.  It is conceivable that one might see the same with a very severe myocardial contusion.  However, the CT confirms that there is no blood flow to the affected myocardium.  One might considertakotsubo, but this would be a very unusual ECG for takotsubo because the ST elevation is focal to one coronary distribution.There was only one initial troponin measured.  It was 73 ng/L (URL = 34 ng/L for men).Because of severe head injury, the ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs