Pearls and Pitfalls in Cardiovascular Imaging Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Case 1 Right atrial pseudotumor due to crista terminalis
- Case 2 Cardiac pseudotumor due to lipomatous hypertrophy of the interatrial septum
- Case 3 Cardiac pseudotumor due to caseous mitral annular calcification
- Case 4 Cardiac pseudotumor due to focal hypertrophic cardiomyopathy
- Case 5 Pseudothrombus in the left ventricle due to microvascular obstruction
- Case 6 Pseudothrombus in the left atrial appendage
- Case 7 Pseudolymphadenopathy due to fluid in the pericardial recess
- Case 8 Valvular masses
- Case 9 Cardiac angiosarcoma
- Case 10 Ventricular non-compaction
- Case 11 Hypertrophic cardiomyopathy mimics
- Case 12 Stress cardiomyopathy
- Case 13 Epipericardial fat necrosis
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Case 5 - Pseudothrombus in the left ventricle due to microvascular obstruction
from Section 1 - Cardiac pseudotumors and other challenging diagnoses
Published online by Cambridge University Press: 05 June 2015
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Case 1 Right atrial pseudotumor due to crista terminalis
- Case 2 Cardiac pseudotumor due to lipomatous hypertrophy of the interatrial septum
- Case 3 Cardiac pseudotumor due to caseous mitral annular calcification
- Case 4 Cardiac pseudotumor due to focal hypertrophic cardiomyopathy
- Case 5 Pseudothrombus in the left ventricle due to microvascular obstruction
- Case 6 Pseudothrombus in the left atrial appendage
- Case 7 Pseudolymphadenopathy due to fluid in the pericardial recess
- Case 8 Valvular masses
- Case 9 Cardiac angiosarcoma
- Case 10 Ventricular non-compaction
- Case 11 Hypertrophic cardiomyopathy mimics
- Case 12 Stress cardiomyopathy
- Case 13 Epipericardial fat necrosis
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Summary
Imaging description
A mass-like area of low signal intensity mimicking thrombus may be encountered in the setting of microvascular obstruction (MO) when cardiac MRI (CMR) is performed after acute myocardial infarction (MI). CMR is often used to assess viability after MI for prognosis and determining the need for possible revascularization. In the acute setting, large transmural MIs may demonstrate MO, which has been associated with poorer outcomes and adverse left venticular (LV) remodeling at follow-up imaging. MO is subendocardial in location and low in signal intensity on late gadolinium enhancement (LGE) images, characteristically surrounded by a zone of increased myocardial signal intensity due to LGE (Figure 5.1). MO represents a densely infarcted area of no-flow within the myocardium where gadolinium cannot reach due to severe micro- vascular damage. MO is recognized by its association with a wall motion abnormality, subendocardial decreased perfusion on dynamic post-contrast images, and a rim of delayed enhancement representing a zone of infarcted tissue with intact microvasculature that surrounds the infarct core with MO.
Importance
MO is important to recognize given the fact that it is associated with poorer outcomes after MI. MO must be correctly differentiated from thrombus, as this may require additional treatment such as anticoagulation therapy, which will expose the patient to additional bleeding risk in the inappropriate setting.
Typical clinical scenario
MO is encountered when viability MRI scans are performed in someone with recent MI. Differentiation of thrombus from MO is important as these patients with hypofunctioning myocardium in the setting of recent MI are at risk for thrombus due to blood stasis.
Differential diagnosis
Thrombus is the most important entity on the differential diagnosis of MO. The location of MO within the wall of the myocardium can help differentiate MO from thrombus. Myocardial location can be clarified by direct comparison of LGE and precontrast images (Figures 5.1, 5.2).
- Type
- Chapter
- Information
- Pearls and Pitfalls in Cardiovascular ImagingPseudolesions, Artifacts, and Other Difficult Diagnoses, pp. 16 - 19Publisher: Cambridge University PressPrint publication year: 2015