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Image challenge
Cardiac diphosphonate uptake
  1. Walter Noordzij1,
  2. Andor W J M Glaudemans1,
  3. Riemer H J A Slart1,
  4. Bouke P C Hazenberg2
  1. 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Walter Noordzij, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, Groningen 9700 RB, The Netherlands; w.noordzij{at}umcg.nl
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http://dx.doi.org/10.1136/heartjnl-2013-305465

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    CLINICAL INTRODUCTION

    An elderly patient was known with generalised osteoarthritis and destruction of the right hip. Six months before, this patient was admitted to a general hospital because of oedema and ventricular tachycardia. No coronary artery disease was found on coronary angiogram and the tachycardia was successfully converted to sinus rhythm. MRI 3 months later showed diffuse asymmetric hypertrophy of the right and LV walls, with diffuse subendocardial and midwall late gadolinium enhancement, and a diminished LVEF of 35%, indicating a restrictive cardiomyopathy.

    At referral to our hospital, the only complaints were fatigue and dyspnoea when climbing the stairs. Physical examination showed no additional abnormalities. Serum analysis revealed elevated levels of N-terminal …

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    Footnotes

    • Contributors All the authors have contributed equally to this work. The corresponding author is responsible for the overall content of this Image Challenge.

    • Competing interests None.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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