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Seventy-one-year-old woman followed with CMR during the course of systemic vasculitis
  1. Mareike Gastl1,2,3,
  2. Din-E-Mujahid Mohammad Faruque Osmany1,4,
  3. Robert Manka1,2,5
  1. 1 Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
  2. 2 Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
  3. 3 Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
  4. 4 Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  5. 5 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Mareike Gastl, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich 8091, Switzerland; gastl{at}biomed.ee.ethz.ch

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?

  1. Microvascular ischaemia

  2. Circular oedema

  3. Endomyocardial fibrosis

  4. Haemorrhage

  5. Apical lipoma

  • cardiac magnetic resonance (CMR) imaging
  • systemic inflammatory diseases
  • heart failure
  • myocardial disease

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Footnotes

  • Contributors MG performed the acquisition of data, drafted the manuscript, and analysed and interpreted the data. DEMMFO performed the acquisition of data and critically revised the manuscript. RM analysed and interpreted the data and critically revised the manuscript.

  • Funding DFG Research Fellowship (GA 2621/1-1) to MG.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Kantonale Ethikkommission Zürich.

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

  • Data sharing statement Further CMR images or clinical history can be made available upon request.

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