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Case report: Myocardial tuberculosis-MRI.

Dixit R, Chowdhury V, Singh S - Indian J Radiol Imaging (2009)

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.

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Blood investigations revealed a hemoglobin level of 10 gm% and normal white blood cell counts... The Mantoux test was positive (20 mm)... Marked nodular thickening was noted at the right atrium–superior vena cava (SVC) junction, which was projecting into the right atrial cavity [Figure 1]... The contrast-enhanced images revealed heterogeneous enhancement of the entire myocardium [Figure 4] with conglomerate ring-like and nodular enhancement in the region of the right atrium–SVC junction, with compression of the SVC... The myopericardium-pericardium interface was indistinct... Typically, echocardiography may show an echogenic immobile mass in the ventricular myocardium in the case of a calcified myocardial tuberculoma... Cardiac MRI is a recent tool and shows a characteristic T2 shortening in tuberculous involvement, similar to that seen in intracranial tuberculomas... The characteristic appearance on T2W images includes a central isointense core, corresponding to central caseation; a hypointense rim, which represents the fibrous capsule; and a thin hyperintense line, which correlates with an inflammatory cellular infiltrate... Post-gadolinium MRI in our patient showed ring enhancement with conglomeration... Conglomeration is due to the presence of a granulomatous lesion and is usually not seen in neoplasms... Both echocardiography and MRI findings are often nonspecific in cardiac masses... In our case, the T2 hypointense character of the diffuse myocardial involvement, including the nodular lesion at the right atrial inlet, and the extracardiac findings of necrotic mediastinal nodes, led us to suspect the possibility of tuberculosis.

No MeSH data available.


T2W dark-blood coronal MRI image shows diffuse myopericardial thickening. The thickening is hypointense on T2W images also and is causing attenuation of the proximal SVC (arrow)
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Figure 0002: T2W dark-blood coronal MRI image shows diffuse myopericardial thickening. The thickening is hypointense on T2W images also and is causing attenuation of the proximal SVC (arrow)

Mentions: Echocardiography revealed normal left ventricular function, intact interatrial and interventricular septa, no pericardial effusion, and a hypoechoic nodular mass in the right atrium, which was reported to be either a neoplasm or a thrombus. Cardiac MRI was performed with ECG-gated T1W, T2W, and postcontrast sequences obtained in multiple planes. Standard cardiac MRI sequences using balanced gradients, e.g., TrueFISP, were performed. Cine images were also acquired. Cardiac MRI showed thickened myocardium with indistinct planes between the myocardium and the pericardium. Marked nodular thickening was noted at the right atrium–superior vena cava (SVC) junction, which was projecting into the right atrial cavity [Figure 1]. Attenuation of the proximal SVC and dilatation of the inferior vena cava (IVC) were also noticed. The lesion appeared iso- to hypointense on both T1W and T2W images [Figure 2]. Multiple, enlarged mediastinal lymph nodes were also noted [Figure 3]. The contrast-enhanced images revealed heterogeneous enhancement of the entire myocardium [Figure 4] with conglomerate ring-like and nodular enhancement in the region of the right atrium–SVC junction, with compression of the SVC. The myopericardium-pericardium interface was indistinct. The mediastinal nodes also showed peripheral enhancement with nonenhancing centers.


Case report: Myocardial tuberculosis-MRI.

Dixit R, Chowdhury V, Singh S - Indian J Radiol Imaging (2009)

T2W dark-blood coronal MRI image shows diffuse myopericardial thickening. The thickening is hypointense on T2W images also and is causing attenuation of the proximal SVC (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2747418&req=5

Figure 0002: T2W dark-blood coronal MRI image shows diffuse myopericardial thickening. The thickening is hypointense on T2W images also and is causing attenuation of the proximal SVC (arrow)
Mentions: Echocardiography revealed normal left ventricular function, intact interatrial and interventricular septa, no pericardial effusion, and a hypoechoic nodular mass in the right atrium, which was reported to be either a neoplasm or a thrombus. Cardiac MRI was performed with ECG-gated T1W, T2W, and postcontrast sequences obtained in multiple planes. Standard cardiac MRI sequences using balanced gradients, e.g., TrueFISP, were performed. Cine images were also acquired. Cardiac MRI showed thickened myocardium with indistinct planes between the myocardium and the pericardium. Marked nodular thickening was noted at the right atrium–superior vena cava (SVC) junction, which was projecting into the right atrial cavity [Figure 1]. Attenuation of the proximal SVC and dilatation of the inferior vena cava (IVC) were also noticed. The lesion appeared iso- to hypointense on both T1W and T2W images [Figure 2]. Multiple, enlarged mediastinal lymph nodes were also noted [Figure 3]. The contrast-enhanced images revealed heterogeneous enhancement of the entire myocardium [Figure 4] with conglomerate ring-like and nodular enhancement in the region of the right atrium–SVC junction, with compression of the SVC. The myopericardium-pericardium interface was indistinct. The mediastinal nodes also showed peripheral enhancement with nonenhancing centers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Blood investigations revealed a hemoglobin level of 10 gm% and normal white blood cell counts... The Mantoux test was positive (20 mm)... Marked nodular thickening was noted at the right atrium–superior vena cava (SVC) junction, which was projecting into the right atrial cavity [Figure 1]... The contrast-enhanced images revealed heterogeneous enhancement of the entire myocardium [Figure 4] with conglomerate ring-like and nodular enhancement in the region of the right atrium–SVC junction, with compression of the SVC... The myopericardium-pericardium interface was indistinct... Typically, echocardiography may show an echogenic immobile mass in the ventricular myocardium in the case of a calcified myocardial tuberculoma... Cardiac MRI is a recent tool and shows a characteristic T2 shortening in tuberculous involvement, similar to that seen in intracranial tuberculomas... The characteristic appearance on T2W images includes a central isointense core, corresponding to central caseation; a hypointense rim, which represents the fibrous capsule; and a thin hyperintense line, which correlates with an inflammatory cellular infiltrate... Post-gadolinium MRI in our patient showed ring enhancement with conglomeration... Conglomeration is due to the presence of a granulomatous lesion and is usually not seen in neoplasms... Both echocardiography and MRI findings are often nonspecific in cardiac masses... In our case, the T2 hypointense character of the diffuse myocardial involvement, including the nodular lesion at the right atrial inlet, and the extracardiac findings of necrotic mediastinal nodes, led us to suspect the possibility of tuberculosis.

No MeSH data available.