{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:46:08Z","timestamp":1782362768321,"version":"3.54.5"},"reference-count":26,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Left ventricular free-wall rupture (LVFWR) is a rare but devastating mechanical complication of acute myocardial infarction (AMI), with reported in-hospital mortality approaching 90% without surgical intervention. Although its incidence has declined in the contemporary primary percutaneous coronary intervention (PCI) era, LVFWR remains an important cause of early post-infarction death, particularly after delayed reperfusion or fibrinolytic therapy. Subacute or contained \u201coozing\u201d ruptures pose a unique diagnostic challenge because hemodynamic stability and nonspecific symptoms can mask the underlying catastrophe, and standard transthoracic echocardiography may fail to visualize a sealed defect. Contrast-enhanced cardiac computed tomography (CT) has emerged as a valuable adjunct in this setting, enabling early recognition and surgical planning. Case Presentation: We report a case of a 51-year-old male, a heavy smoker, with acute lateral ST-segment elevation myocardial infarction (STEMI) treated with thrombolysis at a referring hospital, followed by percutaneous coronary intervention (PCI) to the obtuse marginal branch. Despite reperfusion, he developed persistent pleuritic chest pain and a small pericardial effusion. Cardiac computed tomography (CT) demonstrated a contained (sealed) lateral-wall oozing-type left ventricular free-wall rupture (LVFWR) with thrombus sealing the defect. A multidisciplinary heart team initially opted for diligent observation with frequent echocardiography. Within the first 24 h, the pericardial effusion increased, and echocardiography showed circumferential effusion with lateral wall thickening and hematoma, prompting emergent sternotomy. Intraoperatively, a large posterolateral infarct with an oozing-type LV free-wall rupture was identified. Surgical repair was performed using interrupted pledgeted sutures, native pericardial patch, BioGlue, and an overlying Teflon patch, with intra-aortic balloon pump (IABP) support. This case demonstrates the complementary diagnostic value of multimodality imaging\u2014echocardiography for serial monitoring of the pericardial effusion and regional wall changes, and cardiac CT for direct characterization of the contained (sealed) defect\u2014and the timely transition from conservative to surgical management in oozing-type rupture. The patient recovered uneventfully and was discharged in stable condition. Conclusions: This case highlights the diagnostic value of multimodality imaging\u2014particularly cardiac CT\u2014in detecting contained (sealed) LVFWR when echocardiography is inconclusive. Early recognition and prompt surgical intervention enabled a successful outcome in this otherwise frequently fatal complication.<\/jats:p>","DOI":"10.3390\/diagnostics16121923","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:49:55Z","timestamp":1782121795000},"page":"1923","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Subacute Left Ventricular Free-Wall Rupture After Thrombolysis: From Concealed Rupture on CT to Successful Surgical Patch Repair"],"prefix":"10.3390","volume":"16","author":[{"given":"Mohamed","family":"Ghaleb","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hail Cardiac Centre, King Salman Specialized Hospital, Hail 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Elsayed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hail Cardiac Centre, King Salman Specialized Hospital, Hail 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud F.","family":"Elshahat","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hail Cardiac Centre, King Salman Specialized Hospital, Hail 55476, Saudi Arabia"},{"name":"Department of Cardiology, College of Medicine, Helwan University, Cairo 11795, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Goha","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hail Cardiac Centre, King Salman Specialized Hospital, Hail 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"ALshaghdali","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, University of Ha\u2019il, Hail 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawwaf M.","family":"ALAnazi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hafer Albatin Central Hospital, Hafar Albatin 39521, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed E.","family":"Abdeldayem","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hail Cardiac Centre, King Salman Specialized Hospital, Hail 55476, Saudi Arabia"},{"name":"Department of Cardiology, College of Medicine, Tanta University, Tanta 31511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulieman B.","family":"Haddadin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hail Cardiac Centre, King Salman Specialized Hospital, Hail 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6783-796X","authenticated-orcid":false,"given":"Naif S.","family":"ALGhasab","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, University of Ha\u2019il, Hail 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1161\/CIR.0000000000000985","article-title":"Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement from the American Heart Association","volume":"144","author":"Damluji","year":"2021","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. 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