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Seventy-one-year-old woman followed with CMR during the course of systemic vasculitis.


Gastl, Mareike; Faruque Osmany, Din-E-Mujahid Mohammad; Manka, Robert (2019). Seventy-one-year-old woman followed with CMR during the course of systemic vasculitis. Heart, 105(7):515-530.

Abstract

CLINICAL INTRODUCTION A 71-year-old woman was diagnosed with systemic vasculitis in 2009 and received specific therapy (corticosteroids, cytostatic agents or rituximab in differing order). A transthoracic echocardiography (TTE) in 2013 for follow-up purposes of complications showed hyperechogenic endocardium of the whole left ventricular (LV) apex and cardiac MRI (CMR) was followed to further examine this finding. Using CMR, an apical LV thrombus was detected along with abnormal signal intensities within the endocardium (figure 1A). As a consequence, the existing medication was extended by phenprocoumon to treat the LV thrombus. For tracking the pathologic image features as well as for follow-up of the LV thrombus, serial CMRs were performed at our hospital from 2013 to 2018 (figure 1A). Because of the increasing hyperintense (white arrowheads) and hypointense (red arrowheads) signal spots in cine images of the apex (figure 1A), differently weighted sequences in short-axis view were acquired in the CMR of 2018 (figure 1B).
QUESTION Which of the following is the most likely diagnosis in CMR?Microvascular ischaemiaCircular oedemaEndomyocardial fibrosisHaemorrhageApical lipoma.

Abstract

CLINICAL INTRODUCTION A 71-year-old woman was diagnosed with systemic vasculitis in 2009 and received specific therapy (corticosteroids, cytostatic agents or rituximab in differing order). A transthoracic echocardiography (TTE) in 2013 for follow-up purposes of complications showed hyperechogenic endocardium of the whole left ventricular (LV) apex and cardiac MRI (CMR) was followed to further examine this finding. Using CMR, an apical LV thrombus was detected along with abnormal signal intensities within the endocardium (figure 1A). As a consequence, the existing medication was extended by phenprocoumon to treat the LV thrombus. For tracking the pathologic image features as well as for follow-up of the LV thrombus, serial CMRs were performed at our hospital from 2013 to 2018 (figure 1A). Because of the increasing hyperintense (white arrowheads) and hypointense (red arrowheads) signal spots in cine images of the apex (figure 1A), differently weighted sequences in short-axis view were acquired in the CMR of 2018 (figure 1B).
QUESTION Which of the following is the most likely diagnosis in CMR?Microvascular ischaemiaCircular oedemaEndomyocardial fibrosisHaemorrhageApical lipoma.

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Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Cardiology and Cardiovascular Medicine
Language:English
Date:April 2019
Deposited On:01 Mar 2019 10:17
Last Modified:29 Jul 2020 10:01
Publisher:BMJ Publishing Group
ISSN:1355-6037
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1136/heartjnl-2018-314014
PubMed ID:30442742

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