Society for Cardiovascular Magnetic Resonance 2024 Cases of SCMR case series

Figures

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  Fig. 1. Case 1: Multiview cine bSSFP images that demonstrate a pseudoaneurysm suspected to arise from the LVOT. Oblique LVOT view (A) with large pseudoaneurysm appearing contiguous with the LV cavity lateral and posterior to aortic valve (white arrow). Short-axis views (B, C) of the aortic valve demonstrating pseudoaneurysm (white arrow) MPA (yellow asterisk) with partial volume effects causing contiguous appearance. LVOT view (D) of pseudoaneurysm arising from narrow neck. Short-axis views in systole (E) with residual VSD jet (yellow arrowhead), and diastole (F) with flow jet directed from LVOT into pseudoaneurysm (green arrowhead). bSSFP balanced steady state free precession, MPA main pulmonary artery, LVOT left ventricular outflow tract, LV left ventricular, VSD ventricular septal defect

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  Fig. 2. Case1: Contrast-enhanced MRA in coronal plane demonstrating first-phase (A) enhancement of RV and MPA (red arrowhead) with lack of contrast in the area of the pseudoaneurysm (white arrow). The RVOT is not seen in this plane. Second-phase (B) enhancement of the aorta (asterisk), pulmonary artery (red arrowhead), and pseudoaneurysm (white arrow) with slow pass-through of contrast evidenced by increased signal compared to aorta. RV right ventricle, MPA main pulmonary artery, MRA magnetic resonance angiography, RVOT right ventricular outflow tract

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  Fig. 3. Case 1: Oblique views from contrast-enhanced MR angiogram comparing first and second phases. In a left anterior oblique view (A) first-phase enhancement of RV (orange arrow) and MPA (red arrow) with lack of contrast in the area of the aorta (star) and pseudoaneurysm (white arrow). The RVOT is not seen in this plane. The second-phase enhancement in this plane (B) demonstrates a similar enhancement is noted in the aorta and pseudoaneurysm whereas the pulmonary artery is less enhanced. A short-axis view of the same anatomy in first (C) and second pass (D), respectively, with arrows as described above. MR magnetic resonance, RV right ventricle, MPA main pulmonary artery, RVOT right ventricular outflow tract

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  Fig. 4. Case 1: TEE images in the 120 degree view during catheterization show catheter (orange arrowhead) crossing from under aortic valve (white arrow) into pseudoaneurysm (A). A 5-2 Amplatzer Piccolo Occluder (red arrowhead) was then placed at the communication between the LV and pseudoaneurysm (B). Device placement confirms flow stoppage (white arrowhead) by color Doppler and clot formation beginning in real time (C). During TEE clot formation progressed to fill the pseudoaneurysm (D). TEE transesophageal echocardiography, LV left ventricle

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  Fig. 5. Case 2: Anteroposterior chest x-ray demonstrating clear lung fields and mild cardiomegaly

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  Fig. 6. Case 2: Twelve-lead ECG demonstrating large “Himalayan” P waves (arrows). ECG electrocardiogram

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  Fig. 7. Case 2: T2w fat saturation four-chamber image showing no overt fat infiltration of the RV free wall (arrow). RV right ventricular

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  Fig. 8. Case 3: Axial slice of CTA demonstrating the RCA originates from the left sinus of Valsalva adjacent to the intracoronary commissure and origin of the LCA. The RCA demonstrates acute angle takeoff and narrowing with suggestion of an intramural segment. CTA computed tomography angiography, RCA right coronary artery, LCA left coronary artery

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  Fig. 9. Case 3: Twelve-lead ECG from admission demonstrating ST segment elevation in inferoseptal leads. ECG electrocardiogram

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  Fig. 10. Case 3: Segmented black blood delayed enhancement image (FIDDLE) (A) and single shot PSIR delayed enhancement (B) short-axis images. There is subendocardial hyperenhancement of the basal inferoseptal wall. FIDDLE flow-independent dark-blood delayed enhancement, PSIR phase sensitive inversion recovery

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  Fig. 11. Case 4: CT chest with contrast in axial projection. Bilateral pleural effusions, pulmonary edema, and moderately enlarged mediastinal lymph nodes are present (A). Anomalous origin of the RCA from the left sinus of Valsalva is demonstrated (B). Heterogenous hypoattenuation of the myocardium noted as well (C). CT computed tomography, RCA right coronary artery

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  Fig. 12. Case 4: First-pass perfusion mid short-axis (A) demonstrates a small region of hypoperfusion in non-coronary distribution that corresponded to hypoattenuation on CT and hypoperfusion of the papillary muscles (orange arrow). LGE images in basal short-axis (B) and four-chamber (C) view demonstrate diffuse subendocardial enhancement (orange arrows) involving the LV and RV with small non enhancing LV apical thrombus (red arrow). Mild circumferential pericardial enhancement is also seen (yellow arrows). CT computed tomography, LV left ventricle, RV right ventricle, LGE late gadolinium enhancement