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Case from: Sandra Graciela Rosales Uvera, Leticia Castellanos Caínas, Jorge Vázquez La Madrid, Martha Morelos Guzmán. National Institute of Medical Sciences and Nutrition "Salvador Zubirán",  México city. 

History: a 28 years old female with Scleroderma (SSc) for 11 years and acute angina and elevated creatine kinase (CK).

Investigations: persistent elevation of CK and CK-MB, ECG: inferior and anterior ECG changes.

Cine CMR: Overall low normal LVEF but with regional wall motion abnormalities.




Post contrast CMR: Extensive subendocardial late gadolinium enhancement in the LV and RV, in parts transmural (eg LV apex)



MSCT coronary angiography demonstrated normal coronaries (as shown below) and an apical aneurysm on ventriculography.



MSCT: RCA prox and mid course up to the Crux



MSCT: left main and LAD/LCx bifurcation



MSCT 3D reconstruction


Conclusion: CMR is a reliable and sensitive technique to diagnose heart involvement in SSc providing additional information by visualising myocardial fibrosis and inflammation. Unfortunately, T2-weighted images to detect inflammation were not available in this case. Further study is needed to determine whether cardiac MRI abnormalities have an impact on prognosis and treatment strategy.

1. Cardiac magnetic resonance imaging in systemic sclerosis: a cross-sectional observational study of 52 patients.  Ann Rheum Dis. 2008 Dec 3.

2. Nassenstein K, Breuckmann F, Huger M, et al. Detection of myocardial fibrosis in systemic sclerosis by contrast-enhanced magnetic resonance imaging. Rofo 2008; 180:1054-60.

3. Tzelepis GE; Kelekis NL, Lastiras SC, et al. Pattern and distribution of myocardial fibrosis in systemic sclerosis: a delayed enhanced magnetic resonance imaging study. Arthritis Rheum 2007;56:3827-36.

4. Bezante GP, Rollando D, Sessarego M, Panico N, Setti M, Filaci G, Molinari G, Balbi M, Cutolo M, Barsotti A, Indiveri F, Ghio M. Cardiac magnetic resonance imaging detects subclinical right ventricular impairment in systemic sclerosis. J Rheumatol 2007;34:2431-7.

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COTW handling editor: Dr James Moon

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