Abstract
Extrinsic coronary compression is rare, difficult to diagnose, and can have serious consequences. A patient who had surgery for aortic valve endocarditis with patch closure of a septal abscess was readmitted for myocardial infarction. CT scan revealed compression of the left main stem due to pseudoaneurysm formation under the patch. Positron emission tomography confirmed acute hypoperfusion of the left ventricle, making immediate high-risk reoperation unavoidable. Imaging of the patient at one-year follow-up showed complete thrombosis of the former abscess cavity. Extrinsic coronary compression due to an abscess/pseudoaneurysm is associated with a high mortality rate and surgery appears to be the only possible life-saving treatment. In cases of unclear cardiac symptoms occurring under these circumstances (and thus suggesting extrinsic coronary compression), early imaging for quantitative myocardial perfusion should be considered to assess severity of myocardial ischaemia and thus urgency of surgery.