Case Book

First name and last name

Case 1

34-year-old male with acute myocarditis and preserved LV function (EF 55%)

The red arrow shows:

1. STIR (TIRM) in SAX (short axis) with evidence of myocardial edema lateral

2. Late Gadolinium Enhancement (LGE) in SAX with subepicardial scar / fibrosis lateral

Case 2

A 75-year-old female patient with suspicion of amyloidosis and mild impaired LV function (EF 52%)

Figure „A“ shows:

1. SSFP (steady state precession sequence) Cine in 2 chamber view

2. Late Gadolinium Enhancement (LGE) with pathognomonic pattern of a cardiac amyloidosis

Case 3

76-year-old woman with atypical thoracic pain and preserved systolic LV function without wall motion abnormalities.
Example: adenosine perfusion exam performed without rest-perfusion.

Figure „B“ shows:

1. Normal adenosine-stress-perfusion

2. Stress-induced perfusion defect mostly septal

3. Stress-induced perfusion defect mostly anterior

Case 4

69-year-old man with progressive dyspnea and dilated left ventricle in ECHO

Figures show:

1. Aortic valve insufficiency and tricuspid aortic valve

2. Aortic valve insufficiency and bicuspid aortic valve

3. Aortic stenosis and bicuspid aortic valve

4. Mitral valve insufficiency

Case 5

67-year-old woman with acute thoracic pain

The red arrow shows:

1. Pericardial effusion

2. Pericardial cyst

3. Pleural effusion

Case 6

76-year-old woman with typical thoracic pain and progressive dyspnea since 4-6 months
In ECHO suspected aortic valve stenosis

Figure „C“ shows:

1. Tricuspid aortic valve

2. Bicuspid aortic valve

3. Aortic dissection

Case 7

48-year-old man with acute (antero-anteroseptal) myocardial infarction and preserved LV function, EF 57%

Figure „B“ shows:

1. T2-weighted images with evidence of myocardial edema

2. T1-weighted images with evidence of myocardial edema

3. Artifact

4. Late Gadolinium Enhancement (LGE) with transmural scar/fibrosis

Case 8

The same patient, 48-year-old man with acute (antero/ anteroseptal) myocardial infarction and preserved LV function, EF 57%

Figure „A“ shows:

1. Late Gadolinium Enhancement (LGE) in 3 chamber view and transmural scar/fibrosis within infarct area

2. Late Gadolinium Enhancement (LGE) in 3 chamber view with microvascular obstruction within infarct area

3. T1-weighted images in short axis with evidence of myocardial edema within infarct area

4. Normal Late Gadolinium Enhancement (LGE)

Case 9

54-year-old woman with progressive dyspnea and unexplained structure in echocardiography

Figure A: 3-chamber view; SSFP cine; mass in the left atrium
Figure B: 4-chamber view; T2-weighted image mass with hyperintense signal comparison to the myocardium
Figure C: 2-chamber view; Late Gadolinium Enhancement mass with isointense in comparison to the myocardium

The findings are highly suspected to be a:

1. myxoma

2. lipoma

3. thrombus

4. fibroelastoma

Case 10

32-year-old man with unclear palpitations and dyspnea during stress.
Family history: father- sudden cardiac death at the age of 55.

The image is typical for:

1. amyloidosis

2. hypertrophic cardiomyopathy

3. hypertensive heart disease

4. sarcoidosis

Case 11

32-year-old woman after viral infection with fever and thoracic pain

The figure shows:

1. A und B pericardial effusion

2. A- pericardial cyst; B- pericardial effusion

3. A- pleural effusion; B- epicardial fat

4. A- pleural effusion; B- pericardial effusion

Case 12

46-year-old man, smoker with poorly controlled blood pressure and progressive angina pectoris

The image shows:

1. dissection of Aorta desc

2. dissection of Aorta asc

3. dissection of abdominal Aorta

4. coarctation of the aorta

Case 13

25-year-old man with progressive dyspnea during exercise and normal coronary arteries (cath).
LV-EF 20%. End-diastolic volume index 1.6 ml/m2 (norm value: 1.2)

A typical sign for:

1. sarcoidosis

2. dilated cardiomyopathy, potentially caused by myocarditis

3. arrhythmogenic cardiomyopathy

4. non-compaction cardiomyopathy

Case 14

Late Gadolinium Enhancement images show

a typical sign of:

1. subendocardial/transmural scar/fibrosis typical for coronary heart disease

2. subepicardial/transmural scar/fibrosis typical for myocarditis

3. subepicardial/transmural scar/fibrosis typical for coronary heart disease

4. subendocardial/transmural scar/fibrosis typical for myocarditis

Case 15

28-year-old man with atypical angina pectoris and palpitations

Figures show:

1. Late Gadolinium Enhancement (LGE) in 4 chamber view and in SAX (short axis) with subepicardial scar/fibrosis lateral

2. Late Gadolinium Enhancement (LGE) in 4 chamber view und in SAX (short axis) with intramyocardial scar/fibrosis lateral

3. Late Gadolinium Enhancement (LGE) in 4 chamber view und in SAX (short axis) with subendocardial scar/fibrosis lateral

4. STIR (TIRM) in 4 chamber view und in SAX (short axis) with subendocardial scar/fibrosis lateral

Case 16

57-year-old man with acute chest pain

Figures show:

1. acute myocarditis with evidence of myocardial edema lateral in T2-weighted images

2. Late Gadolinium Enhancement (LGE) with non-ischaemic subepicardial scar/fibrosis lateral

3. subacute myocardial infarction with evidence of myocardial edema lateral in T2-weighted sequence and microvascular obstruction (MVO) in Late Gadolinium Enhancement (LGE)

4. acute myocardial infarction with evidence of myocardial edema lateral in T2-weighted technique and thrombus in Late Gadolinium Enhancement (LGE)

Case 17

46-year-old male, with known aortic valve insufficiency

Images show:

1. aneurysm oft the Aorta desc

2. aneurysm of the Aorta asc

3. abdominal aortic aneurysm

4. coarctation of the Aorta

Case 18

76-year-old woman after emotional stress, with atypical thoracic pain and troponine elevation. No coronary stenosis. The CMR image shows an apical ballooning.

The images are typical for:

1. Dilated cardiomyopathy

2. Tako-Tsubo cardiomyopathy

3. Amyloidosis

4. Thrombus

Case 19

47-year-old man after heart attack 4 months ago and apical acinesia

The arrow shows:

1. Late Gadolinium Enhancement (LGE) and microvascular obstruction (MVO)

2. apical thrombus

3. Slow Flow in T2-weighted images

Case 20

64-year-old man with typical thoracic pain and preserved systolic LV function.
Adenosine perfusion.

The arrow shows:

1. Stress-induced perfusion defect mostly lateral

2. Stress-inducted perfusion defect septal/anterosetal

3. Stress-induced perfusion defect mostly inferior

4. Dark rim artefakt

Case 21

The white arrows on 4CV-Cine image („A“) indicate a right heart dilatation.
The red arrow on Cine image („B“) – short axis - shows a „D-Sign“.
These changes are pathognomonic for

1. arrhythmogenic cardiomyopathy

2. right ventricular pressure overload

3. myocardial infarction with right-sided localization

Case 22

The red arrow shows:

1. tricuspid aortic valve

2. bicuspid aortic valve

3. mitral valve stenosis

4. pulmonary valve

Case 23

Late Gadolinium Enhancement (LGE) images in „A“ 2CV, „B“ short axis show:

1. Non-ischemic, subepicardial scar / fibrosis, typical for myocarditis

2. Intramyocardial scar suggestive for dilated cardiomyopathy

3. Amyloidosis

4. Ischemic subendocardial scar / fibrosis after anterior wall infarction

Case 24

To differentiate acute and chronic myocardial infarction applying CMR, the following sequences may be helpful, except:

Die Late Gadolinium Enhancement (LGE) Bilder („A“ 2CV, „B“ kurze Achse) zeigen:

1. Cine images with the request for wall motion abnormality

2. Late Gadolinium Enhancement(LGE) with the request for microvascular obstruction

3. T2-wighted sequence with the request for myocardial edema

4. T2-Mapping with the request for a microvascular obstruction

5. T2-wdighted sequence with the request for myocardial edema

Case 25

The white arrow shows:

1. STIR/TIRM in short axis (SAX) with evidence of myocardial edema septal / anterior

2. Late Gadolinium Enhancement (LGE) in short axis (SAX) with tramsmural scar/fibrosis lateral

3. Late Gadolinium Enhancement (LGE) in short axis (SAX), a typical image of amyloidosis

Case 26

The images show:

1. aortic insufficiency / tricuspid aortic valve

2. aortic insufficiency / bicuspid aortic valve

3. mitral valve insufficiency

5. aortic valve stenosis

Case 27

The images show:

1. tricuspid aortic valve stenosis with aortic dilatation

2. bicuspid aortic valve stenosis with aortic dilatation

3. mitral valve stenosis

4. pulmonal valve stenosis

Case 28

The figure above shows:

1. Fabry disease

2. Non-compaction cardiomyopathy

3. apical form of hypertrophic cardiomyopathy

4. LV-tumor

Case 29

The arrows show:

1. dilatation of the Aorta asc

2. dilatation of the Aorta desc

3. left atrium

4. main pulmonary artery

Case 30

Continuation of case no. 29

Images above show:

1. Tetracuspide pulmonary valve

2. Tetracuspide mitral valve

3. Tetracuspide aortic valve

4. Tetracuspide tricuspid valve

Fallsammlung

Case Book

Enrico_meART