AJR Teaching File: Left Ventricular Mass in a Patient with Ischemic Heart Disease

摘要

A 50-year-old old man with known coronary artery disease and two prior anterior myocardial infarctions presents witk worsening dyspnea (New York Heart Association class III-TV). Radiologic Description Cardiac MRI shows a dyskinetic aneurysmal anterior and apical left ventricular wall on the cine balanced steady-state free precession (b-SSFP) sequence images in diastolic and systolic two-chamber and three-chamber views (Figs. 1A-ID and supplemental video in. three-chamber plane [Fig. SI; see www.arjon-Kne.org]). The contrast-enhanced inversion recovery images (Figs. IE and IF) show transmural enhancement of the left ventricular apex and anterior wall, which is indicative of a scar. A dark low-signal-intensity mass is visible adherent to the aneurysmal enhanced and scarred myocardium. The mass is seen as a thickening of the apical myocardium on the cine b-SSFP images and is nearly isointense to the myocardium on this sequence. The left ventricle was dilated and measured 70 mm in end-diastole, and the ejection fraction was reduced at 35%.