Cases of SCMR

A 54 year-old Indian male, presented to the cardiology clinic with progressive increasing shortness of breath over the last 4 months (NYHA class III). He did not complain of chest pain or palpitations. No systemic symptoms like fever or weight loss were present. The rest of his past medical history was negative. A chest X-ray was concerning for a pericardial effusion. Transthoracic echocardiogram was done, that confirmed the presence of pericardial effusion, however, additionally raised the possibility of a cystic lesion in the pericardium with possible coronary involvement. The ventricular function was normal (reported LVEF 55%).

Number 22-12: Utility of Cardiac MRI in Confirming Spontaneous Coronary Artery Dissection

A 62 year-old female with a past medical history of hypertension and hyperlipidemia presented with recurrent episodes of sudden onset, mid-sternal chest pain radiating to the neck and upper back while at rest for the past day. On physical exam, the patient was noted to be hypertensive to 187/98 mmHg and tachycardic to 103 bpm with no other remarkable finding. Serial high-sensitivity troponins trended upward from < 4 ng/L to 23,121 ng/L (normal <= 17 ng/L). Other lab values were within normal range. A 12-lead ECG demonstrated an incomplete right bundle branch block with T-wave inversions in the anterior leads.

Number 22-11: Simultaneous Occurrence of Myocardial Infarction and Broken Heart Syndrome

Our 89 year-old grandma has suffered from hypertension, diabetes, dyslipidemia, and severe polyneuropathy for many years. She has been very unsteady with her gait and frequently falls. One day, she fell on her way to answering the front door and sustained a severe laceration to her face above the eyebrow. It took a while until after great effort and under tremendous stress, she was finally able to call our dad. Our dad, a physician, immediately responded and treated the head laceration. Since our grandma did not want to go to the hospital, our dad treated her at home and stayed with her overnight. The next day, she complained of weakness and shortness of breath.

Number 22-10: Rapid Recurrence of a Primary Cardiac Sarcoma Assessed by CMR

A 24 year-old male with a history of cardiac tumor status post resection presented to the emergency department with several days of cough productive of bright red blood. He reported that the cough was constant and not associated with chest pain or palpitations. On review of systems, he only endorsed shortness of breath but otherwise denied additional constitutional, cardiovascular, or infectious complaints.

Number 22-09: Concomitant dual genetic cardiomyopathies in a patient complicated by stroke

A 60 year-old woman was referred to cardiology clinic to investigate asymptomatic ECG abnormalities detected during workup for elective hemicolectomy for malignancy. Her medical history included rheumatoid arthritis, obstructive sleep apnoea, osteoarthritis and obesity. Her younger half-brother died in his 50’s from sudden cardiac death whilst playing sports. Medications included metoprolol XL and warfarin. Physical examination was unremarkable.

Number 22-08: LGE in Neonates

Number 22-07: RVOT Thrombosis without Valvular Extension in a Repaired Tetralogy of Fallot Patient

Number 22-06: Child with Fulminant Myopericarditis and Tamponade after COVID-19

An 8 year-old healthy male with a past medical history of mild persistent asthma, unvaccinated against coronavirus disease 2019 (COVID-19), was admitted with abdominal pain, emesis, and bilateral hip and thigh pain. He was diagnosed with acute COVID-19 by initial rapid molecular test which was subsequently confirmed by PCR testing with negative antibody testing. He had no preceding fevers. Exam was notable for poor peripheral perfusion. Initial inflammatory markers were normal, and an ECG demonstrated low voltages (Image 1). He required fluid resuscitation both in the emergency department and pediatric intensive care unit but eventually required inotropic support with epinephrine and milrinone. Chest computed tomography showed extensive bilateral lung opacities and atelectasis, consistent with COVID pneumonia (Image 2). Cardiac workup showed elevated troponin (ref <0.029 ng/mL) and BNP (ref <60 pg/mL), with a peak of 2.47 ng/mL and 2,379 pg/mL, respectively. Initial transthoracic echocardiogram showe severe left ventricular systolic dysfunction (LVEF 31%) without left ventricular dilation (LVEDD 3.57 cm, z-score -1.8) with a moderate-sized pericardial effusion (Movie 1). The effusion was globally distributed with a maximum dimension of 1 cm from subcostal imaging.

Number 22-05: COVID-19 Vaccine-related Myocarditis

A 16 year-old male presented to our institution for CMR 6 months after an episode of COVID-19 vaccine-related myocarditis (CVAM). He had previously been admitted to an outside hospital with mid-sternal chest pain three days after the second dose of Pfizer-BioNTech COVID-19 vaccine. There was no associated fever, shortness of breath, palpitations, or dizziness. Laboratory work-up revealed elevated inflammatory markers and troponin I level (peak = 9.78 ng/ml, normal value ≤0.08 ng/ml). The work-up was negative for other infectious, rheumatologic and toxicologic etiologies. There was no evidence of other end-organ damage. ECG showed ST segment elevations in precordial leads V4-V6, and no arrhythmias.

Number 22-04: Left Ventricular Diverticulum masquerading as Pseudoaneurysm

Number 22-03: Unguarded Mitral Orifice with DORV and Normally Related Great Arteries: CMR Diagnosis

Number 22-02: A Case of Metastatic Choroid Malignant Melanoma

A 63 year-old male, with a known past medical history of left choroid melanoma presented with increasing dyspnea, hypertension, hyperlipidemia ongoing tobacco use, and progressive 30-pound weight loss and associated anorexia. Lab work was obtained indicating hyponatremia with a sodium of 128 mg/dL, elevated LDH of 293, and a leukocytosis of 21,300. A CT scan of the chest obtained 2 months prior to presentation identified numerous diffuse nodules throughout the lung fields with associated mediastinal and hilar lymphadenopathy.

Number 22-01: An Infant with Giant Coronary Artery Aneurysm in Cardiovascular Magnetic Resonance due to multisystem inflammatory syndrome following COVID-19

Cases of SCMR 2021

Number 21-04: Newly developed heart failure: What is the Etiology?

70 year-old female nursing home resident with past medical history of hypertension, hypothyroidism, peripheral vascular disease, and obsessive-compulsive disorder presented to emergency department with shortness of breath of supposedly several days duration. She denied chest pain, palpitation, or cough.

Number 21-03: A Case of Arrhythmogenic Cardiomyopathy with Left Ventricular Involvement

A 16 year-old highly athletic boy with no significant past medical history or family history, presented with recurrent presyncope. During a basketball game, he developed an hour-long episode of dizziness, pallor, and diaphoresis. EMS obtained a 12-lead electrocardiogram and found him to be in monomorphic ventricular tachycardia at a rate of 250 bpm, and successfully cardioverted him. He was admitted to an outside hospital where a limited echocardiogram reportedly demonstrated normal cardiac anatomy and function (Figure 1). An EKG obtained during a brief episode of non-sustained ventricular tachycardia demonstrated origin from the right ventricular outflow tract (Figure 2 top). His baseline EKG was normal with a RSR' pattern in V1 and V2 (Figure 2 bottom). He was referred for cardiac MRI (CMR) for further evaluation.

Number 21-02: Left Ventricular Hypertrophy: The Other Side of the Coin

A 34 year-old naval officer, otherwise fit and healthy, with no known family history of cardiomyopathies, presented with chest pain (CP), poorly tolerated atrial fibrillation and progressive hypotension. An echocardiogram showed asymmetric septal hypertrophy, with preserved left ventricular ejection fraction (LVEF) and severe left atrial enlargement. As high sensitive Troponin I (hs-TnI) was elevated, with persistent CP, a coronary angiogram was performed showing unobstructed coronaries and a chest CT ruled out pulmonary embolism. Blood tests showed mildly increased inflammatory markers. A cardiovascular magnetic resonance (CMR) was requested.

Covid-19

Number 21-02: A Case of Elusive Recurrent COVID-19 Pericarditis?

Number 21-01: Eosinophilic Myocarditis

A 70 year-old female with a past medical history of asthma presented to the Emergency Department for further evaluation of atypical chest pain, orthopnea, and progressive dyspnea on exertion. Initial laboratory findings showed markedly elevated high-sensitivity troponin T (1,200 ng/L), NT-pro BNP (4,400 pg/mL), and hypereosinophilia (6.48 x 109/L). Her electrocardiogram (Image 1) demonstrated sinus tachycardia with diffuse ST depressions, new from prior studies.

Covid-19

Number 21-01: The Role of Multimodality Imaging During a Severe COVID-19 Infection

Cases of SCMR 2020

Number 20-10: Transient Ischemic Attack after LVAD explantation

Number 20-09: Acute chest pain with abnormal CMR

Number 20-08: Asymmetrical Septal Hypertrophy in cases with strong family history of Hypertrophic Cardiomyopathy: It is not always HCM

Number 20-07: New Murmur in a Patient with Pectus Deformity

Number 20-06: Tricuspid Valve Papillary Fibroelastoma

Number 20-05: A Case of Subendocardial Fat Deposition in a Patient with Eosinophilic Granulamotosis with Polyangiitis

Covid-19

Number 20-05: CMR Findings in a Young Patient with Frequent PVCs in Setting of Prior COVID-19 Infection

Number 20-04: Its not ARVD!

Covid-19

Number 20-04: Subacute perimyocarditis caused by COVID-19 infection

Number 20-03: Ventricular Tachycardia and Endocardial Fibroelastosis in Congenital Pulmonic Stenosis

Covid-19

Number 20-03: Clinically Suspected Myocarditis in a SARS-COV-2 Positive Patient

Number 20-02: Rare Aortic Arch Anomaly Identified by CMR in Patient with Klippel-Feil Syndrome

Covid-19

Number 20-02: Cardiomyopathy in Setting of COVID-19 Infection

Number 20-01: Diagnosis of a coronary sinus atrial septal defect by 4D flow MRI

A 15 year-old asymptomatic girl was followed by cardiology for a small perimembranous ventricular septal defect (VSD). A routine echocardiogram demonstrated spontaneous closure of the VSD, as well as right atrial and ventricular enlargement. Significant volume loading from a VSD would cause left heart dilation which was not seen. The unexpected right heart dilation suggested a previously unnoticed atrial level shunt. She was referred for surgical closure of a presumed secundum atrial septal defect (ASD). However, on review of imaging prior to surgery, an enlarged coronary sinus was noted.

Covid-19

Number 20-01: CMR Findings in Covid-19 Associates Myocarditis

Cases of SCMR 2019

Number 19-08: Value of cardiac MRI in diagnosis and prognostication in a case of relapsing Eosinophilic Granulomatosis with Polyangiitis with myocardial involvement

A 23 year-old migrant from Zimbabwe presented with a 10 day history of flu-like symptoms, myalgias, chest pain, palpitations, Troponin I of 1.8 mcg/L (normal <0.040) and peripheral eosinophilia of 3.42 x109/L (normal <0.6 x109/L). He had been diagnosed with anti-neutrophil cytoplasmic antibody (ANCA) negative eosinophilic granulomatosis with polyangiitis (EGPA) with cardiac involvement 2 years prior, in 2015.

Number 19-07: New Murmur in an Asymptomatic Ten-year-old

An asymptomatic 10 year-old male visited his pediatrician for his regular attention deficit and hyperactivity disorder (ADHD) follow-up. A new systolic ejection murmur was heard. Chest x-ray showed an abnormal aortopulmonary window with enlargement of the left atrial shadow. ECG showed P-mitrale (M-shaped P-waves) in lead II and biphasic P-waves in lead V1, suggesting left atrial enlargement (Figure 1). These results prompted a referral to pediatric cardiology.

Number 19-06: The role of modality imaging in evaluation of new-onset ventricular tachycardia

A 56 year-old male with a past medical history of antiphospholipid syndrome, chronic kidney disease stage III (resulting from a renal infarct from an embolic thrombus), and essential hypertension presented to the emergency department after a near syncopal episode while he was uploading boxes. Upon EMS arrival, he was noted to be in monomorphic ventricular tachycardia (Figure 1) that needed immediate synchronized cardioversion with subsequent resolution of his symptoms.

Number 19-05: Neonatal Giant Atrial Hemangioma – A rare cardiac tumor

A 30 year-old gravida 2 para 1 female was referred for evaluation of a fetal intracardiac mass noted on routine obstetric ultrasound. Fetal echocardiogram at 26-weeks’ gestation revealed a single, large, homogenous, hyperechoic cardiac mass occupying bi-atrial cavities with unobstructed intra-cardiac flows. There was normal biventricular systolic function and no pericardial effusion. Serial fetal echocardiograms showed the size of the mass increasing in proportion to the rest of the cardiac size.

Number 19-04: Early Diagnosis of a Systemic Disease by CMR prevents Complications

A 19 year-old woman presented with a 2-week history of painful atraumatic left ankle swelling associated with painful plantar-flexion and petechial rash on the left foot. Six weeks prior to presentation, she experienced flu-like illness with headache, fevers and myalgias/athralgias. On examination, there was a non-blanching petechial rash over the dorsum of the left foot with associated edema and warmth but no erythema. Peripheral pulses were normally palpable with normal capillary refill. Neurological exam of the foot was normal except for 4/5 power on plantar flexion due to pain. Ultrasound of the leg showed a thrombus in the lateral tarsal artery raising a possibility of an embolus.

Number 19-03: Hypovascular renal cell carcinoma infiltrating the left atrium through the pulmonary veins

A 43 year-old male patient underwent left side radical nephrectomy four months ago for removal of biopsy proven clear renal cell carcinoma. The patient did not receive chemotherapy. The patient presented with complaints of shortness of breath and hemoptysis. Echocardiogram revealed a left atrial mass with no right heart involvement detected. As renal cell carcinomas most commonly involve the heart by extension through the IVC and right-side chambers, a left atrial thrombus was initially suspected in this case. The patient was referred for cardiac MRI to verify the diagnosis prior to starting anticoagulants.

Number 19-02: Left Ventricular Thrombus or Myxoma: The Use of Multimodality Imaging

A 46 year-old woman presented with complaints of generalized abdominal pain. Initial work up with a Computerized Tomography (CT) scan of abdomen/pelvis revealed wedge shaped areas of low attenuation in her spleen and right kidney which was consistent with infarction. She also had adynamic ileus secondary to bowel infarction along with findings suggestive of an embolus in her superior mesenteric artery (SMA). CT also revealed a possible 2 x 4.1 cm “mass” within the left ventricle of the heart.

Number 19-01: A Case-Study in MRI-based Automated Detection of Left-ventricular Cardiotoxicity in a Breast Cancer Patient after Chemotherapy Treatment

A 54 year-old woman was diagnosed with left-sided breast cancer in October 2015. She was treated with chemotherapeutic agents (CA) Adriamycin (cumulative dose of 400 mg/m2), cyclophosphamide and trastuzumab (Herceptin®). She also received ADO–trastuzumab emtansine (Kadcyla®) for a history of metastatic breast cancer previously receiving treatment with Herceptin®. During her chemotherapy regimen an echocardiogram revealed lowered left ventricular (LV) systolic function (LVEF 48%).

Cases of SCMR 2018

Number 18-15: New Pericardial Mass in a Patient with a History of Recent Kawasaki Disease: Use of Cardiac MRI for Diagnosis and Surgical Planning

A 6 year-old male presented to the emergency department with a 2 week history of intermittent fever, fatigue, anorexia, and weight loss. His past medical history is significant for a history of refractory Kawasaki Disease diagnosed 1 year prior to presentation.

Number 18-14: Congenital Lymphatic Malformation Mimicking a Para-cardiac Mass in a Neonate

Number 18-13: Mystery revealed: It takes Cardiovascular Magnetic Resonance to diagnose Inferior Sinus Venosus Defect in an adult status post Total Anomalous Pulmonary Venous Return repair

Number 18-12: Eosinophilic Myocarditis

Number 18-11: Late Diagnosis of Interrupted Aortic Arch in a Child with Kabuki Syndrome

Number 18-10: Infected Left Ventricular Pseudoaneurysm Diagnosed with Cardiac MRI

Number 18-09: Pulmonary valve papillary fibroelastoma

A 59 year-old female with suspected dilated cardiomyopathy and no valvular pathology was referred for cardiac MRI. Resting EKG showed normal sinus rhythm, left ventricular hypertrophy, and non-specific T wave abnormalities.

Number 18-08: Levoatriocardinal Vein with Normal Intracardiac Anatomy: A Case of Misidentification

Number 18-07: The Diagnostic Value of CMR in a Patient with Cogenital Heart Disease and Infectious Endocarditis

A four year-old patient with pulmonary atresia and ventricular septal defect (PA/VSD) after surgical repair with Contegra conduit (bovine jugular vein graft, Medtronic, Minneapolis, MN) at the age of 2 years underwent repeated CMR scan under general anesthesia for evaluation of aortic regurgitation and assessment of left ventricular volumes. CMR showed significant aortic regurgitation through a perforation in the right coronary cusp with mild left ventricular dilatation and mildly impaired left ventricular systolic function. Surprisingly, severe stenosis of the pulmonary conduit due to a mobile mass with severe dilatation and severe dysfunction of the right ventricle was recognized. These findings were not seen on echocardiogram performed 2 months before and were suspicious of infectious endocarditis (IE).

Number 18-06: A left ventricular pseudoaneurysm before and after surgical correction

Number 18-05: How to image the heart when it is in the abdomen: A case of Pentalogy of Cantrell

Number 18-04: Swollen inter-ventricular septum: A Phenotype mimicking HCM

A 32 year-old male patient with no relevant medical history presented with acute onset of chest pain. His initial ECG showed ST segment elevation in leads V1 to V3 with reciprocal ST segment depression in inferior leads

Number 18-03: Lower Extremity Edema: Long Term Complication of Partial Anomalous Pulmonary Venous Return Repair

A 57 year-old woman with a history of sinus venosus atrial septal defect and partial anomalous pulmonary venous return (PAPVR) repaired in childhood presented to the adult congenital heart disease clinic with junctional rhythm and significant lower extremity swelling. She had three surgeries during childhood for congenital heart disease. She did not have consistent care for her heart disease and her surgical history was not clear at presentation. In addition to her congenital heart disease she had known active hepatitis C infection. A month before presentation, she was evaluated for dizziness with bradycardia. She continued to have intermittent bouts of dizziness without syncope.

Number 18-02: Management of a Nearly Occlusive Neonatal Pulmonary Artery Thrombus

A term male infant with a birth weight of 3,623 grams failed a routine pulse oximetry screening at approximately 36 hours of life. There were no pregnancy complications aside from maternal tobacco use. Pre- and post-ductal saturations were 94% and 86-88%, respectively. An echocardiogram was notable for a large mass in the right pulmonary artery.

Number 18-01: An Unusual Presentation of Behçet’s Disease

A 22 year-old Caucasian gentleman was transferred as an emergency to our cardiac surgical center with a large unexplained right ventricular mass, with evidence of a large pulmonary embolus. He had a 6-week history of fevers and rigors following a dental infection and had been admitted to another hospital 10 days previously for investigation. He was otherwise fit and well, with no previous medical history or medications. He had been treated with a course of penicillin V at the time of initial dental infection, and had presented a number of times to his local emergency department in the preceding weeks with fevers, mouth ulcers, pleuritic chest pain and had raised inflammatory markers (white cell count of 18 cells per cubic millimeter of blood with neutrophilia, C-reactive protein (standard assay) of 120 mg/mL, erythrocyte sedimentation rate of 80 mm/hr) with negative blood cultures and no localizing signs of infection.

Cases of SCMR 2017

Number 17-12: A “Swinging Heart”

A 71 year-old male with a previous history of working-exposure to glass components was admitted to our hospital with persistent complaints of chest tightness, shortness of breath and edema in the lower limbs that started 3 months prior to his admission. An echocardiogram from a local hospital identified a nodule on the right-sided of the pericardium and large pericardial and pleural effusions. Percutaneous drainage was performed and 30 mL were obtained from the pericardium and 500 mL from the pleurae, both of hemorrhagic appearance. Biochemical analysis of pericardial and pleural fluids was not performed and cytological analysis was negative for malignant cells. Medical treatment was initiated and the patient remained asymptomatic for the following 3 days. The patient’s symptoms recurred and rapidly worsened so he was admitted to our institution for further examination and treatment.

Number 17-11: The Ventral Cardiac ‘Flop’ – A CMR Sign In Congenital Absence of the Pericardium

A 64 year-old Caucasian lady was seen at the rapid access chest pain clinic with a 6-month history of atypical chest pain. Her risk factors for cardiovascular disease were smoking, hypertension and familial risk. She was referred for coronary angiography that revealed moderate right coronary artery/posterior descending artery stenosis while left ventriculography suggested an unusual cardiac orientation with a laterally displaced and vertically oriented heart. She was referred to us for stress perfusion cardiovascular magnetic resonance (CMR) imaging.

Number 17-10: Cardiac Involvement of Myeloid Sarcoma

A 64 year-old male with history of Acute Myelogenous Leukemia (AML) status post bone marrow transplant (BMT) in complete remission presented with dyspnea when laying on his right side which resolved when supine or in the left lateral decubitus position. He also reported occasional shortness of breath with mild exertion. Only tachycardia was noted on clinical examination. There were no clinical signs of SVC syndrome.

Number 17-09: Concealed Right Ventricular Infraction Revealed by Cardiac MRI

A 59 year-old male patient, diabetic, hypertensive presented with a non ST-segment elevation myocardial infarction (NSTEMI) (Image 1). The peak troponin I was 5.9 ng/ml (reference level up to 0.02 ng/ml). Coronary angiography, performed within four hours from the onset of chest pain, showed a significant proximal left anterior descending (LAD) artery lesion for which two drug eluting stents were deployed. The right coronary artery (RCA) was dominant with sluggish flow and an insignificant proximal lesion. No stents or angioplasty were performed on the RCA (Movie 1,2). ECG was recorded after catheterization (Image 2).

Number 17-08: Intra-Myocardial Haemangioma Mimicking Hypertrophic Cardiomyopathy-Evaluation by Multimodality Imaging

A 57 year-old female presented with atypical chest pain. Her past medical history was unremarkable. Initial ECG (Figure 1) revealed inferolateral T wave inversion without evidence of left ventricle hypertrophy by voltage criteria; however, serial cardiac enzymes were negative. Acute coronary syndrome was ruled out and the patient was referred for stress echocardiography. The stress echocardiogram revealed normal LV size and systolic function with no resting or inducible regional wall motion abnormality. However there was an incidental finding of asymmetric thickening of the distal inter-ventricular septum raising suspicion for atypical hypertrophic cardiomyopathy.

Number 17-07: Invisible Cardiac Lesion

A 43 year-old female with a past medical history significant for hypertension and mild rheumatoid arthritis and no known cardiac disease experienced the sudden onset of chest pain, malaise, and pre-syncope at an airport. Paramedics were alerted and she was found to have inferior ST- segment elevations on an ECG (see Figure 1). The patient was immediately taken to the nearest cardiac catheterization laboratory and was found to have no significant coronary artery lesions. Her peak CK-MB was in the 50s ng/mL and her peak Troponin was 15 ng/mL. A transthoracic echocardiogram demonstrated an inferior wall motion abnormality and a left ventricular ejection fraction of 35-45% (see Figures 2-6). Her symptoms and inferior ST segment elevations subsequently resolved. She was diagnosed with coronary vasospasm and treated with diltiazem, carvedilol, aspirin, clopidogrel, nitroglycerin, simvastatin, and lisinopril. After discharge, she participated in cardiac rehabilitation but reported low energy and fluid retention that was managed with low-dose diuretics.

Number 17-06: Unexpected jeopardy: CMR in atypical chest pain but chronic aortic dissection with cardiac schwannoma

Number 17-05: Cardiovascular Magnetic Resonance Imaging of a Right Atrial Mass – A Case Report

Number 17-04: Aortitis Masquerading as Pericardial Effusion

Early diagnosis of aortitis is crucial for proper management of the disease and prevention of future sequelae. Clinical presentation of aortitis is often nonspecific and patients with early stages of aortitis are often asymptomatic. Traditionally, the diagnosis of aortitis is invasive often requiring arterial biopsy. However, advanced imaging can be an invaluable tool to assist clinicians in the evaluation of patients for possible aortitis with high specificity, and sensitivity [4]. In this case report, we present a patient with atypical presentation of aortitis, and describe how different imaging modalities can be used to assist in the diagnosis of aortitis. A 43 year-old female with a history of asthma and uterine fibroids presented with shortness of breath. She reported chest tightness and was awakened from sleep with chest pain that radiated down her left arm. She had no prior history of cardiac diseases. There was recent history of fever, and productive cough.

Number 17-03: Congenital malformation of the coronary drainage system and trabecular architecture detected by cardiovascular magnetic resonance

Number 17-02: Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis

A 34 year-old female presented with a history of loss of appetite, unintended weight loss, and heart failure. Her past history was remarkable for a diagnosis of eosinophilic polyangiitis (EGPA). She also had a prior bout of middle cerebral artery syndrome earlier in the year of uncertain etiology, although a coexisting PFO was found and thought to possibly represent a source of paradoxical embolism. A CT of the chest was performed to evaluate suspected pulmonary involvement, and demonstrated left ventricular enlargement. A transthoracic echocardiogram depicted a thrombus in the left ventricle. A CMR exam was then performed to further evaluate this finding, assess left ventricular function, and determine possible cardiac involvement by EGPA.

Number 17-01: Large Pericardial Bronchogenic Duplication Cyst: Utility of Cardiac MRI in Diagnosis of a Rare Entity

A 31 month old female was diagnosed with a large secundum atrial septal defect (ASD) following evaluation for a murmur as neonate. At that time, a separate “third chamber” was noted that appeared contiguous with the lateral left atrium that was believed to represent a cor triatriatum membrane. One pulmonary vein was seen draining into the left atrium. The other pulmonary veins were thought to drain into the “third chamber” however transthoracic echocardiography never definitively resolved this by color flow Doppler. She remained clinically asymptomatic although notably required three admissions for upper respiratory infections during the previous year. She was scheduled for elective closure of the ASD and resection of the cor triatriatum membrane. An intraoperative transesophageal echocardiogram was performed, which demonstrated normal pulmonary venous return and concern for a large extracardiac mass compressing the left atrium. The operative repair was delayed and the patient was transferred under anesthesia to the MRI suite to obtain a cardiac MRI for further evaluation of the mass prior to same day resection.

Cases of SCMR 2016

Number 16-13: Infiltrative Mass: Cardiac MRI to assess for Autotransplantation Candidacy

Number 16-12: Hypertrophic cardiomyopathy, apical aneurysm, and inducible ischemia

The case of a 85 year-old lady is presented who complain of atypical chest pain. After a markedly abnormal ECG showing high voltage R waves and deep, inverted T waves on precordial leads, an echocardiographic study is performed, suggesting non-obstructive hypertrophic cardiomyopathy (HCM). A CMR exam is requested to: 1) confirm the diagnosis; 2) precisely determine the extent of the process; 3) establish the presence or not of myocardial fibrosis; and 4) to rule out myocardial ischemia.

Number 16-11: Magnetic resonance late gadolinium enhancement detects acute aortic intramural hematoma

An 81 year-old male patient presented with sudden and intense chest pain. On the emergency ward, a transthoracic echocardiogram was performed showing an enlarged and wall-thickened thoracic aorta. Computed tomography angiography confirmed the enlarged and wall-thickened thoracic aorta. In non-contrast images, a high-attenuation crescentic thickening of the aortic wall suggested an intramural hematoma or aortitis (Figure 1). 18F-FDG-PET suggested that there was no overt inflammation but findings were equivocal (Figure 1). The patient was stable without pericardial effusion, periaortic hematoma, or large aortic aneurysm; therefore, a cardiac magnetic resonance imaging study was performed in the next 12 hours to rule out aortitis (1).

Number 16-10: Organization of Intracardiac Thrombus: Insights from Inside a Giant Left Ventricular Pseudoaneurysm

Number 16-09: Subarachnoid Hemorrhage Unmasks Aortic Coarctation In A Young Man

A 20 year-old male with a history of hypertension presented to the emergency department because of a severe headache. On examination, the patient was confused and disoriented. His BP was 135/61 mmHg, temperature 35.6°C (97.9°F), pulse 78, and respiratory rate 24. Cardiovascular exam showed a regular heart rhythm, a grade III/VI diastolic murmur heard best in the third left intercostal space, strong pulse, no edema, warm skin, and capillary refill of <3 seconds. No lower extremity blood pressures were obtained.