Usefulness of Delayed Enhancement Magnetic Resonance Imaging for Detecting Cardiac Rupture Caused by Small Myocardial Infarction in a Case of Cardiac Tamponade

Abstract

elayed enhancement magnetic resonance imaging (DE-MRI) has excellent spatial resolution and compared with other cardiac imaging techniques, such as echocardiography and single photon emission computed tomography (SPECT), it can detect a small or a subendcadial myocardial infarction (MI). 1 Here we report a case of cardiac tamponade in which the cause was initially unknown and DE-MRI was useful to detect a cardiac rupture due to a small transmural infarction. Case ReportA 76-year-old man was admitted to hospital after losing consciousness during exercise. He had complained of back pain that continued all night for 1 week before the admission. His blood pressure was 66/30 mmHg and heart rate was regular and 101 beats/min. The echocardiogram showed an echo-free space in the cardiac circumference, although the global left ventricular wall motion was almost normal and there was no segmental wall motion abnormality (Fig 1). His electrocardiogram recorded a counter-clockwise rotation of the QRS complex, an abnormal Q wave only in the aVL lead, and ST elevation in the inferior and anterior leads (Fig 2). The patient was diagnosed as having cardiac tamponade of unknown causes and underwent pericardiocentesis immediately. After the removal of 100 ml of bloody fluid, his systolic blood pressure rose to 130 mmHg and he regained consciousness. His leukocyte count was 6,800 cells/ l, and the serum concentrations of aspartate aminotransferase, creatine kinase and lactate dehydrogenase were 54 IU/L, 234 IU/L and 243 IU/L, respectively. Additionally, the qualitative troponin T test was positive. From the results, it was suspected that the cardiac tamponade was the result of a cardiac rupture caused by a recent MI. He was then treated with angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker and -blocker, and his systolic blood pressure was controlled between 100 and 120 mmHg.After 4 weeks, he underwent both DE-MRI and dipyridamole stress 201 Tl myocardial SPECT. The magnetic resonance imaging (MRI) used a 1.5 T MR system with the combined use of 8-channel cardiac phased array coil (Signa Infinity Twinspeed, GE Medical Systems, WI, USA). DE-MRI was based on the inversion recovery prepared fast gradient echo sequence. Five to 9 slices of 10 mm in thickness were used to cover the entire heart. Contrast agent (0.2 mmol/kg Gd-DTPA-BMA; Daiichi Pharma, Tokyo, Japan) was intravenously injected, and DE-MRI was performed after 15 min. A transmural enhancement was clearly detected in a very narrow range of the lateral wall of left ventricle (Fig 3), although dipyridamole stress 201 Tl myocardial SPECT indicated only a slight hypoperfusion in the posterolateral segment (Fig 4). Re-distribution of 201 Tl was observed in the rest image, suggesting a significant coronary stenosis in a branch of the left coronary artery. Coronary angiography revealed a severely stenotic lesion in the obtuse marginal branch of the left circumflex artery. There were no significant stenotic lesions in the left anterior descending artery or th...

The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis

“…Myocardial magnetic resonance imaging (MRI) is non-invasive, does not expose the patient to ionizing radiation, and is excellent for spatial resolution. Delayed enhancement (DE)-MRI has been shown useful to detect small and focal myocardial abnormality [14][15][16]. Several reports have shown that the distribution of DE in cardiac sarcoidosis may be different from that in myocardial infarction [17][18][19][20][21][22][23][24][25].…”

Left Ventricular Free-Wall Rupture After Acute Myocardial Infarction Imaged by Cardiovascular Magnetic Resonance

“…The use of CMR in a case of cardiac rupture has been reported (11). In our case, the diagnosis was based on CMR and confirmed at surgery; the relatively early diagnosis probably contributing to the successful outcome.…”

Cardiac Rupture in Acute Myocardial Infarction: Post-mortem MR Imaging

“…1 Cardiac rupture is a serious complication of acute myocardial infarction (AMI), and detailed MR features of this event remain unknown despite a few case reports of its visualization using cardiac MR imaging. [2][3][4] We herein characterize the MR features of cardiac rupture using MR imaging in vitro and histological assessment of AMI in an autopsied case.…”