Intramural dissecting hemorrhage of the myocardium
| Autor: | Amr Mahmoud Zaki, Ashraf Mohamed Al-Agamy, Mohamed Hamdy Mahmoud Zahran, Walid Mohamed Ahmed Mohamed, Mohamed Youssef Aref, Tarek Mohamed Rashad |
|---|---|
| Jazyk: | angličtina |
| Předmět: |
medicine.medical_specialty
Ejection fraction medicine.diagnostic_test business.industry Magnetic resonance imaging Steady-state free precession imaging medicine.disease Stenosis Pseudoaneurysm medicine.anatomical_structure Internal medicine medicine Cardiology cardiovascular system Myocardial infarction Radiology cardiovascular diseases Thrombus business Artery |
| Zdroj: | Journal of the Saudi Heart Association. (2):148 |
| ISSN: | 1016-7315 |
| DOI: | 10.1016/j.jsha.2013.03.121 |
| Popis: | A 59-year-old man suffering anterior myocardial infraction 3 months ago with persistent dyspnea. Echocardiography revealed marked hypokinesia of the anterior and septal left ventricular walls with reduced ejection fraction (30%.) as well as turbulent flow at the apical region was noted with suspected apical thrombus formation. Coronary artery angiogram images show total occlusion of the LAD at its proximal and mid segment, tight long 90% stenosis of the first obtuse marginal artery as well as 99% mid segment stenosis of the RCA. Cardiac MRI was done and steady state free precession (SSFP) cine images revealed localized myocardial tearing and a flap appeared at the LV apex with a small tear at the flap containing fresh blood. Delayed-enhancement magnetic resonance imaging (intravenous dosage of 0.2 mmol/kg of Gad-DTPA; inversion recovery delay 260 ms; delayed time 10 min) revealed that the flap was enhanced and deviated toward the LV cavity and scarred enhanced myocardium deviated toward the epicardial border denoting the diagnosis of an intramural dissecting hemorrhage of the myocardium at the LV apical region. This entity accounts for fewer than 10% of cardiac ruptures and may occur after myocardial infarction, chest trauma, or surgery, or even spontaneously. Preoperative diagnosis is difficult, with differential diagnosis including pseudoaneurysm and intracavitary thrombus. Considering the poor prognosis of patients treated medically (less than 10% survival), corrective surgery is usually the treatment of choice. |
| Databáze: | OpenAIRE |
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