Dr. Pepe’s Diploma Casebook: Case 7 – SOLVED!

Dear Friends,

MRI of the heart is now a standard tool in diagnostic imaging. This week, I want to show you an MRI examination of a 62-year-old man with dyspnoea.

Fig. 1

Fig. 2

Most likely diagnosis:

1. Hypertrophic cardiomyopathy
2. Cardiac amyloidosis
3. Cardiac sarcoidosis
4. None of the above

Click here for the answer

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    15 Responses to : Dr. Pepe’s Diploma Casebook: Case 7 – SOLVED!

    1. Jess says:

      Most conspicuous finding is of a pericardial effusion…HCM, cardiac amyloid are better diagnosed with their specific delayed enhancement patterns on T1+ C sequences: thickened myocardium demonstrating delayed (possibly multifocal hyperenhancement), amyloid demonstrates diffuse (almost all of myocardium is involved) delayed hyperenhancement. In my normal practice, I would take a look at the patient’s CXR to exclude BHL or other features of sarcoid (cardiac sarcoid is a cause of recurrent pericardial effusion) – but common things being common I would have to say that the most likely diagnosis is D. None of the Above and the pericardial effusion is secondary to other causes particularly MI…

    2. vishal kalia says:

      T2W SSFP images showing assymetrical thickening of the left ventricular walls predominantly involving the septum(basal septum). the atria are not dilated and show normal wall thickness. the right ventricular wall is normal. based on above findings, my diagnosis will be hypertrophic cardiomyopathy. In amyloidosis, there will be concentric ventricular wall thickening , bilateral atrial enlargement and /or nodular thickening of the atrial wall and interatrial septum(not seen in this case). IN sarcoidosis, there are increased T2 signal intensity foci in thickened myocardium due to inflammation and pericardial involvement-not seen in present case. contrast enhanced images will further help to confirm the diagnosis with different patterns of contrast enhancement in these diseases.

    3. sanil says:

      hypertrophic cardiomyopathy

    4. Sneha says:

      pericardial effusion

    5. Ricardo Macareno says:

      It identifies interventricular septal thickening and pericardial effusion in moderate amounts. To suggest the diagnosis of amyloidosis and sarcoidosis must perform MRI with intravenous gadolinium, to objectify the enhancement pattern taardio infarction in correlation with clinical data.
      The diagnosis is hypertrophic cardiomyopathy.

    6. Kelvin says:

      Hypertrophic cardiomyopathy.

    7. Marcy says:

      Hypertrophic cardiomyopathy (septal) + a small interventricular comunication + Pericardial effusion

    8. genchi bari italia says:

      Ispessimento della parete ventricolare sx e del setto interventricolare, con riduzione della cavità ventricolare; si associa versamento pericardico.Si esclude pertanto una cardiomiopatia di tipo “restrittivo”(amiloidosi-sarcoidosi-glicogenosi-emocromatosi….).Il reperto depone per una cardiomiopatia di tipo ” ipertrofico”, escludendo, per ovvie ragioni, una miocardiopatia di tipo”dilatativo”.

    9. Marce & Victor says:

      There is a diffuse wall thickenig of both ventricles that associated to pericardial effusion strongly sugesst us a cardiac amyloidosis, but the late enhancement sequences would be useful to differenciate this entity from hypertrophic cardiomiopaty.

    10. Marcy says:

      there is a diffuse wall thickening of both ventricles that associated to pericardial effusion strongly suggest us a cardiac amyloidosis. But the late enhancement sequence would be useful to differenciate this entity from others.

    11. Dr J says:

      Hypertrophic cardiomyopathy.