Myocardial calcification and subendocardial fatty replacement of the left ventricle following myocardial infarction

We report a 70 years old man with old myocardial infarction of the anteroseptal wall. He had an acute anterior myocardial infarction ten years ago and coronary angiography showed a total occlusion of the left middle anterior descending coronary artery. He underwent a multidetector cardiac computed tomography for rule out another coronary stenosis before the surgery of a postrenal aortic aneurysm. The unenhanced computed tomography image realized for the quantification of the coronary calcium reveals a low-attenuation curvilinear stripe consistent with subendocardial fat at the anterior ventricular wall and a curvilinear focal apical left ventricular calcification. In this case without a precontrast CT the subendocardial fat could have been misinterpreted , leading us to conclude that a hypoenhancement area (perfusion defect) secondary from the reduced delivery of contrast in the subendocardium was present. The presence of calcium in the myocardium can make not trustworthy the estimation of the size of the infarct and the presence or absence of viability in the same one especially when it is realized by means of magnetic resonance.