Cardiac Imaging in Systemic Diseases: What the Clinician should Know

Figures

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  Fig. (1). A. Parasternal long axis echocardiographic images of a 56-year-old woman with uveitis and pulmonary sarcoidosis. Note a small pericardial effusion, left atrial dilation, mild to moderate mitral regurgitation, and reduced ejection fraction. Thinning of the basal segment of the interventricular wall caused by fibrosis and granulomatous infiltration (arrow) is also seen. B. Parasternal short axis view shows systolic dysfunction and thickening of the posterior papillary muscle (arrow).

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  Fig. (2). CMR of a patient with advanced sarcoidosis revealing severe systolic dysfunction, biventricular dilation and apical thrombus (arrow) (A), diffuse scarring of the ventricular walls including the apex (B, C D) and thickening of the mitral sub-valvular apparatus.

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  Fig. (3). Typical findings of amyloidosis with cardiac infiltration: (A) Apical 4 chamber view of an echocardiogram showing dilation of both atria and thickening of the mitral valve leaflets and both ventricles. (B) Parasternal short axis view depicting a preserved LV ejection fraction. (C) CMR demonstration of biatrial dilatation, AV valve insufficiency, biventricular and interatrial septal thickening. (D) Parasternal long axis view revealing a myocardial granular pattern. (E) Subcostal window indicating dilation and diminished excursion of the IVC compatible with elevation of right heart pressures. (F) CMR showing LGE in a global and diffuse pattern, including the interatrial septum, without a coronary distribution.

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  Fig. (4). Cardiac Amyloidosis: (A) Apical 4 chamber view of an echocardiogram showing biventricular wall thickening, systolic dysfunction and mild AV valvular insufficiency. (B) Transmitral pulsed waved Doppler revealing a 'restrictive' filling pattern (prominent E wave and shortened deceleration time). (C) Strain curve with reduced longitudinal deformation of the inferior basal and septal myocardial segments. (D) Two chamber view on CMR illustrating a small pericardial effusion, systolic dysfunction and elevation of the right sided venous pressures.

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  Fig. (5). Cardiac amyloidosis. 99mTc-PYP bone seeking tracer image obtained in an 87-year-old female. Planar anterior and left lateral projections of semi-quantitative visual analysis showing score 2-3: moderate to high uptake equal or greater than bone (A, B, C). SPECT imaging acquired according to Dorbala et al. [37] (D).

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  Fig. (6). Elderly patient with Wegener’s presenting with Heart Failure. Notice thickening and invasion of the left atrial wall (A, C) (arrow), mitral and aortic valves causing severe insufficiency (B, D, E).

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  Fig. (7). CT scan of the patient described in Fig. (6) showing the extent of infiltration in the left atrial wall (arrows).

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  Fig. (8). Transesophageal echocardiographic still-frame images (A and B) depicting marked thickening of the atrial surface of both mitral leaflets (lupus vegetations) and associated functional regurgitation.

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  Fig. (9). Carcinoid heart disease. Apical 4 chamber view echocardiogram (A) demonstrating right atrial enlargement, thickening, shortening and restriction of the tricuspid valve causing both obstruction and regurgitation as demonstrated in the Doppler image (B). Note the rapid decay of the tricuspid regurgitation velocity commonly seen in this condition.

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  Fig. (10). Apical 4 chamber echocardiographic view showing marked endocardial fibro-thrombotic thickening of both ventricles (arrows) in a Brazilian patient affected by EMF.