Reversibility of myocardial edema and regional wall motion abnormalities in a non-Takotsubo-like pattern in a lightning strike survivor detected by cardiac MRI – a case report

Figures

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  Figure 1. Lichtenberg figures and exit wound. Shown are Lichtenberg figures on both sides of the chest (→).

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  Figure 2. Exit wound. Shown is an exit wound on the left thigh (→).

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  Figure 3. Acute cardiac MRI. Extensive septal myocardial oedema without evidence of scarring in a non-Takotsubo-like pattern after lightning strike. Shown are three representative short axis slices through the left and right ventricles (basal, mid-ventricular, and apical) as well as a long-axis four-chamber view (4CV). For each region, late gadolinium enhancement (top row) and T2 mapping (bottom row) are shown. The significant prolongation of the septal T2 relaxation times (bottom row, *) is an expression of regional myocardial oedema as is septal myocardial thickening (↔). No scars were detected in the corresponding late gadolinium enhancement slices (upper row). Presence of a discrete, not haemodynamically relevant, pericardial effusion (↑). Septal hypokinesia is evident in the corresponding cine TrueFISP sequences (online video supplement).

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  Figure 4. Cardiac MRI course 3 months after the lightning strike. Complete resolution of the structural changes without any sequelae. Again, three representative short-axis slices through the left and right ventricles (basal, mid-ventricular, and apical) and a long-axis four-chamber view (4CV) is depicted. For each slice, the late gadolinium enhancement (top row) and T2 mapping (bottom row) are shown. Normalization of septal T2 relaxation times (bottom row, *) as a correlate of oedema resolution. Likewise, we noticed complete resolution of the septal myocardial thickening (↔). In the corresponding late gadolinium enhancement sections (upper row), there still were no scars detected. Residual pericardial separation (↑). Resolution of septal hypokinesia is visible in the corresponding cine TrueFISP sequences (online video supplement).