|Case of the Week|
How to submit a case-of-the-week.
History: A 64 year old female presented with a long history of vague dyspnea on exertion and intermittent palpitations. She had a history of mild exercise intolerance for the last 50 years with difficulty keeping up with her peers as early as high school. She had a normal physical exam with no murmur or gallop. A recent 24 hour Holter monitor was concerning for intermittent supraventricular tachycardia with possible atrial fibrillation. Her transthoracic echocardiogram showed left atrial dilation and concern for possible cor triatriatum with a membrane across the mid left atrium. A nuclear stress test was negative with no evidence of infarct or ischemia. She had a transesophageal echocardiogram that showed no evidence of cor triatriatum, severe left atrial dilation, dilated right coronary artery ostium, and continuous unidentified flow into the left atrium. A cardiac MRI and chest MRA was performed to evaluate the etiology of left atrial dilation in the setting of a dilated coronary artery.
History: A 19-year old male with no previous cardiovascular history presented with NYHA Class III heart failure symptoms. Electrocardiogram on presentation showed normal sinus rhythm with Himalayan P waves (P waves > 5 mm and peaked in lead II), right bundle branch block and right axis deviation.
NUMBER 16-06: CARDIOVASCULAR MAGNETIC RESONANCE IMAGING IN VENTRICULAR TACHYCARDIA: SEARCH FOR THE CULPRIT
History: A 55-year old female patient presented after an episode of syncope secondary to polymorphic ventricular tachycardia (pVT). Her medical history included impaired glucose tolerance and deep venous thrombosis 17 years ago. She did not use any medication. On examination, vital signs were normal and only raccoon eyes were observed. CT-cerebrum excluded intracranial pathology. During the hospital stay she experienced six episodes of pVT with minimal prolongation of the QT interval, which converted to sinus rhythm either spontaneously or with defibrillation.
NUMBER 16-05: THE ROLE OF MULTI-MODAL IMAGING IN THE DIAGNOSIS AND MANAGEMENT OF A CARDIAC VASCULAR MALFORMATION
History: An asymptomatic 4-month-old male infant was referred for assessment of a heart murmur. An echocardiogram demonstrated a large (19x11 mm) mass arising from the basal inter-ventricular septum, encroaching on the right ventricular outflow tract (RVOT), producing mild RVOT obstruction.
History: A 50 year old mixed race man was admitted in Coronary Care Unit after an episode of syncope and sudden onset chest pain associated with palpitations.
History: A 52 year old man with a history of arterial hypertension was admitted because of sustained monomorphic ventricular tachycardia (Fig. A) reverted by amiodarone.
NUMBER 16-02: NEONATAL CARDIAC MASS: AN EXAMPLE OF THE UTILITY OF CARDIAC MRI IN TISSUE CHARACTERIZATION
History: The patient's mother presented at 33 weeks gestation for a fetal echocardiogram secondary to
History: A 17 year old male with a history of autism presented to the emergency room with a three day history of subjective fever, otitis media and acute onset of chest pain for one day
History: An 85 year old male veteran had an incidental discovery of a large aneurysm in the region of a ductus diverticulum on a CT chest 2 years prior.
History: A 64-year-old male, a diabetic and a smoker, with no relevant cardiovascular history presented with a syncope during sexual intercourse after using sildenafil, with complete recovery after 10 minutes.
History: A 70-year-old female residing in a remote, rural part of Pakistan presented with several days of chest pain and dyspnea concerning for acute coronary syndrome.
History: A 46 year old woman was referred to our hospital for investigation of vaginal blood loss.
History: A 64 year old male presented one year after cardiac transplant for routine follow up. A 2D transthoracic echocardiogram revealed a mobile, echogenic lesion along the inferior wall of the right atrium.
History: A symptomatic 50 year old woman previously diagnosed as congenitally corrected transposition of great arteries (L-TGA) was referred to our department.
History: A teenager who collapsed during athletic activity, has T wave inversion on ECG.
History: A 23 year-old gentleman presented to the coronary care unit with “dull aching” central chest pain without pleuritic or pericarditic features.
History: An 84 year-old man presented after an out-of-hospital cardiac arrest and was successfully resuscitated.
History: A 63 year old healthy man was seen in consultation for chest pain and an abnormal electrocardiogram (EKG).
History: An asymptomatic 42 year-old male is submitted for a CMR study after an echo scan showing asymmetric hypertrophy involving the apical segment of the left ventricle. A noticeable highly echogenic signal is described at the endocardial border of the thickened apical region.
History: 49-year-old gentleman diagnosed with T3aN0M1 metastatic renal cell carcinoma in September 2010, underwent a right-sided nephrectomy the same month. He presented to our emergency department with complaints of constant chest pain, which waxes and wanes in intensity and sharp in characteristic.
History: A 70 year-old male had presented approximately 6 months prior to another hospital with fatigue, weakness, chest pain and dyspnea. At that time, left heart catheterization showed non-obstructive coronary artery disease and elevated left ventricular end-diastolic pressures with a restrictive filling pattern.
History: A 15-year-old boy presented with progressively worsening exertional dyspnea following balloon aortic valvotomy in infancy for congenital aortic stenosis.
History: A 16-year-old boy was found to have an abnormal ECG during his appendectomy surgery. His background was remarkable for a small muscular VSD which had undergone spontaneous closure on an echocardiogram performed two years prior.
History: 15 year old boy with Tetralogy of Fallot (TOF) status post a valve-sparing repair who was referred for a cardiac MRI due to pulmonary valve insufficiency.
History: A 17 year-old male with a history of d-transposition of the great arteries status post arterial switch operation at age 3 days presented with increasing exercise intolerance.
History: A 34 year-old female with a 2-month history of shortness of breath and new onset lower extremity edema presented to the emergency department for assessment.
History: A three year old child presents with hemitruncus. This case illustrates the importance of an XMR facility for clinical decision-making in pediatric cardiology.
History: A 58 year-old man was admitted to hospital with a short history of rapidly progressive breathlessness, haemoptysis, weight loss and fatigue.
History: An example of a false (pseudo) aneurysm and a true aneurysm in two different patients.
History: A 75-year-old Caucasian female, diagnosed with intestinal carcinoid tumor presented with a syncopal episode.
History: A 77-year-old man presented with a 2-week history of low-grade fever and dyspnea. Chest X-ray revealed large pleural effusions on the right side.
History: A 77-year-old immuno-competent man was referred to our emergency room for onset of dyspnea, orthopnea and paroxysmal nocturnal dyspnea.
History: A 16 year old male previously dilated from congenital post-ductal aortic coarctation (AoCo) through balloon angioplasty at age of 1 year-old, was referred to cardiovascular imaging to rule out any possible complications derived from high-performance and continuous physical activity as a professional soccer player.
History: A 70 year old man with hepatitis B, solitary kidney and remote coronary artery bypass grafting from 17 years prior presented with an inferior myocardial infarction.
History: A 62 year-old Caucasian man presented to the Cardiology Clinic for a routine perioperative evaluation prior to juxtarenal abdominal aortic aneurysm repair.
History: A 3 year old girl was evaluated in clinic with a history of a previously diagnosed right aortic arch and a patent ductus arteriosus.
History: A 22 year old female was seen for a routine follow up of her apical muscular ventricular septal defect (VSD).
History: An asymptomatic 3 year old was evaluated for a murmur. Physical examination was significant for a widely split second heart sound with an ejection systolic murmur in the left upper sternal border.
History: Cardiac aspergilloma is a very rare entity. The diagnosis is usually made by direct observation of the fungal mass during surgery, biopsy, or pathology. We report the CMR findings in a patient with cardiac aspergilloma.
History: A 44 year old male status-post repair of dextro-transposition of the great arteries presented with atypical chest pain in the context of hypertension and hypercholesterolaemia.
History: A 33-year-old man was suspected of having a regurgitant quadricuspid aortic valve on the basis of transthoracic echocardiography following the incidental discovery of a diastolic murmur.
History: A 70-year male presented with gradual deterioration, breathlessness, and peripheral oedema as well as bilateral pleural effusions. He had previous CABGx4(LIMA LAD, VG to OM, Diagonal and RCA).
History: A 23 year-old morbidly obese female presented with dyspnea on exertion. Shw was born with Down Syndrome, double outlet right ventricle, complete atrioventricular septal defect and pulmonary stenosis and underwent surgical correction at age 5. She also has a reported history of myocarditis at age 19 with resultant systolic dysfunction (EF 35-40%).
History: Clinical History: A 40 year-old male with no significant past medical history was referred for a chest CT due to the discovery of an enlarged pulmonary artery on routine chest x-ray.
History: This case report describes a case of co-incidental coronary disease, Takotsubo cardiomyopathy and hypertrophic cardiomyopathy, where cardiac magnetic resonance imaging (MRI) was crucial in establishing the diagnoses.
History: 19yo asymptomatic male with an abnormal left ventricular finding and ectopy.
History: A six year old girl was referred to pediatric cardiology for evaluation of a heart murmur.
History: A fifteen years old girl with known bicuspid aortic valve was admitted with ineffective endocarditis due to Strept. Agalactiae and treated with antibiotic therapy.
History: A 53 year-old man with no significant past medical history presented to our hospital reporting severe substernal chest pressure with associated diaphoresis that woke him up from sleep. A standard 12-lead electrocardiogram (figure 1) showed marked ST-segment elevation in leads V1, V2, and V3 and in the inferior leads II, III, and aVF, with ST depression in leads I, L, with T wave inversion in V5 and V6.
History: Progressive aortic root dilatation after repair of tetralogy of Fallot is a rare but recognized complication.The cardiovascular magnetic resonance in this case report represented a key tool for the surgical approach before a tetralogy of Fallot reoperation.
History: An asymptomatic fifteen-year-old boy with dextrocardia and complete transposition of the great arteries (CTGA) who had arterial switch operation and closure of ventricular septal defect (VSD) during infancy.
History: A previously healthy 18-year-old woman presented to an outside medical facility with fever and left scapular pain and was found to have an elevated D-dimer.
History: A 52 year old asymptomatic male affected by hypertension and without other remarkable past medical history presented to the outpatients clinic for check-up.
History: 74 year old gentleman was discharged after an uneventful recovery following four vessel coronary artery bypass grafting, which was done for worsening angina pectoris and triple vessel disease.
History: A 60-year-old man, originally from Sardinia, with diabetes and hypertension presented with sporadic, nonspecific precordial discomfort of short duration.
History: A 65 year old, non-diabetic, normotensive and obese female complained of exertional angina of four years’ duration. She had a transient ischemic attack 15 days ago. Physical examination was unremarkable.
History: 59 yo female two months post abdominal hysterectomy, bilateral salpingo-oophorectomy for a high grade endometrial leimyosarcoma.
History: A 61 year old gentleman presented with worsening breathlessness for 2 years. He had a past history of COPD and idiopathic pericardial constriction which had been treated many years earlier by pericardial stripping through a median sternotomy.
History: We present a case of a 27 year old Native American male with a past medical history of complex congenitally corrected transposition of great arteries (CCTGA) with associated double outlet right ventricle (DORV), dextrocardia, subpulmonary stenosis, subpulmonary VSD and PDA.
History: 69 year-old male with history of endovascular abdominal aortic aneurysm repair, COPD, and metastatic lung cancer status post resection on radiation therapy was referred to a cardiothoracic surgeon for consideration of aortic valve replacement (AVR) after a routine transthoracic echocardiography (TTE) at an outside facility revealed evidence of severe aortic stenosis (AS) with a peak gradient of 105 mmHg and aortic valve area (AVA) of 0.78 cm2.
History: A four week old male infant was noted to be dysmorphic including hypertelorism, bilateral inguinal herniae, umbilical hernia and bilateral club feet. A right axillary mass was noted on examination; ultrasound revealed the mass to be a dilated and tortuous vessel but could not conclude definitively whether it was venous or arterial.
History: History: A 46-year-old man with history of Hodgkin’s lymphoma treated with radiation 20 years ago. Four years previously he had undergone pleurodesis for recurrent pleural effusions. He recently developed worsening dyspnea, lower extremity edema, and ascites. At another facility, he was treated initially for interstitial lung disease with bronchodilators without improvement of his symptoms. He was referred to our center for further evaluation.
History: The patient is a previously healthy 9 year old child who presented to her primary care doctor with complaints of her feet turning white.
History: Patient presenting with constitutional symptoms and right atrial mass. Several differential diagnosis and CMR helped to point the correct diagnosis and plan treatment
History: 27 year-old male with the history of heterotaxy syndrome, Tetralogy of Fallot with pulmonary atresia, and right aortic arch.
History: A 51 year old man was referred for a CMR study. He had repair of Tetralogy of Fallot in childhood.
History: A 49 year-old male presented with a 10-day history of worsening shortness of breath, paroxysmal nocturnal dyspnea and orthopnea
History: 68 year old female, smoker, with a history of hyperlipidemia, and type 2 diabetes mellitus. In 2007 she suffered from a myocardial infarction with incomplete revascularization.
History: a 18 year old male with tuberous sclerosis presents for cardiac MR after an abnormal echogenic foci was identified on echocardiogram.
History: 53yo male with dyspnea and left atrial prolapsing sarcoma.
History: A 28 year old woman with history of Wolf-Parkinson-White syndrome status-post ablation of a right posterolateral bypass tract in four years earlier who was referred to us for evaluation of an abnormal transthoracic echocardiogram.
History: A 65 year old patient presented with symptoms of worsening right heart failure. Transthoracic echocardiography showed right heart dilatation and severe tricuspid regurgitation with grossly abnormal, thickened and retracted tricuspid valve leaflets.
History: 63 year old male patient initially presented to the outpatient clinic with fatigue and progressive shortness of breath.
History: 69-year-old male with a history of previous myocardial infarction developed increasing exertional dyspnoea and angina four years after initial presentation. CMR demonstrated a left ventricular aneurysm with thrombus.
History: A 43-year old man with no remarkable past medical history presented with progressive dyspnea and peripheral edema. ECG showed frequent polymorphic ventricular ectopic beats Echocardiogram showed LV systolic dysfunction.
History: Myocardial contusion is a ubiquitous cause of hospitalization. The most common etiologies are auto-pedestrian accident, CPR, fall from heights>20’, and motor vehicle accidents.The majority of patients will have a troponin leak and may have EKG changes. Since the right ventricle is the most anterior portion of the heart it is commonly traumatized.
History: An 42 y/o asymptomatic male underwent CMR for screening.
History: We describe two cases with known and previously documented mitral valve (MV)prolapse on transthoracic echocardiography.
History: Anterior Mitral Valve Cleft in the Presence of a Primum ASD.
History: A 38 year-old man without symptoms. His father was diagnosed with right ventricular arrythmogenic cardiomyopathy after heart transplant for ventricular arrhythmias and dilated cardiomyopathy.
History: 72 yo female with susceptibility artifact from oral iron ingestion.
History: An 18-year-old African American male was admitted to our Emergency Department after developing sudden and severe chest pain.