病例 331:心脏肉样瘤病。

IF 12.1 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiology Pub Date : 2024-11-01 DOI:10.1148/radiol.232441
Muhammad Umer, Usman Sagheer, Wilfred Furtado, Matthew Shotwell, Jonathan Joshi, Mrinali Shetty, Dinesh K Kalra
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引用次数: 0

摘要

病史:患者 43 岁,男性,既往病史不详,因新发位颞部头痛、头晕和双下肢无力 1 天来急诊就诊。患者否认胸痛、气短、咳嗽或最近接触过病人。他没有服用任何药物,也否认酗酒或使用违禁药物。生命体征无异常。体格检查结果显示,患者左侧前臂偏斜,双侧肢体畸形,左侧更为明显。常规实验室检查结果正常,包括全血细胞计数、代谢检查和高敏肌钙蛋白水平。心电图显示窦性心动过速,心率每分钟102次,下导联T波倒置,左轴偏离,不完全右束支传导阻滞,以及频繁的室性早搏。胸部 X 光片无异常。无对比增强的头部 CT 显示没有急性颅内异常。无造影剂增强的脑部核磁共振成像显示多处急性梗死,涉及左侧小脑后下动脉分布、右侧小脑半球、右侧颞叶中叶和右侧内囊后缘。头颈部的 CT 血管造影显示,右侧大脑后动脉近起源处闭塞,远端血流微弱。鉴于这些检查结果与急性缺血性脑卒中的心源性栓塞病因有关,医生为患者进行了经食道超声心动图检查。超声心动图显示左心室轻度收缩功能障碍,射血分数为 40%,全身轻度运动功能减退,在随后的心脏 CT 和 MRI 检查中还发现了一个额外的发现,在此予以披露。患者开始接受全身抗凝治疗和指导性药物治疗,以治疗射血分数降低的心力衰竭。胸部 CT 显示没有淋巴结病变或肺实质或肺间质异常的迹象。患者接受了冠状动脉 CT 血管造影术 (CCTA),随后进行了心脏磁共振成像。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Case 331: Cardiac Sarcoidosis.

History: A 43-year-old male patient with no known past medical history presented to the emergency department with new-onset bitemporal headache, dizziness, and bilateral lower extremity weakness for 1 day. The patient denied chest pain, shortness of breath, cough, or recent exposure to sick individuals. He was not on any medications and denied alcohol or illicit drug use. Vital signs were unremarkable. Physical examination was notable for a left-sided pronator drift and bilateral dysmetria that was more pronounced on the left. Results of routine laboratory workup, including complete blood count, metabolic panel, and high-sensitivity troponin level, were normal. An electrocardiogram revealed sinus tachycardia with a heart rate of 102 beats per minute, T-wave inversions in the inferior leads, left axis deviation, incomplete right bundle branch block, and frequent premature ventricular contractions. A radiograph of the chest was unremarkable. CT of the head without contrast enhancement demonstrated no acute intracranial abnormalities. MRI of the brain without contrast enhancement revealed multiple acute infarcts involving left posterior inferior cerebellar artery distribution, right cerebellar hemisphere, right mesial temporal lobe, and right posterior limb of the internal capsule. CT angiography of the head and neck showed an occlusion of the right posterior cerebral artery near its origin, with a trace of distal flow. Given that these findings were concerning for a cardioembolic etiology of acute ischemic stroke, transesophageal echocardiography was performed. This showed mild left ventricular systolic dysfunction with an ejection fraction of 40%, mild global hypokinesis, and an additional finding also seen at subsequent cardiac CT and MRI, disclosed herein. The patient was started on systemic anticoagulation and guideline-directed medical therapy for heart failure with reduced ejection fraction. CT of the chest showed no evidence of lymphadenopathy or abnormalities in the lung parenchyma or interstitium. Coronary CT angiography (CCTA) was performed, followed by cardiac MRI.

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来源期刊
Radiology
Radiology 医学-核医学
CiteScore
35.20
自引率
3.00%
发文量
596
审稿时长
3.6 months
期刊介绍: Published regularly since 1923 by the Radiological Society of North America (RSNA), Radiology has long been recognized as the authoritative reference for the most current, clinically relevant and highest quality research in the field of radiology. Each month the journal publishes approximately 240 pages of peer-reviewed original research, authoritative reviews, well-balanced commentary on significant articles, and expert opinion on new techniques and technologies. Radiology publishes cutting edge and impactful imaging research articles in radiology and medical imaging in order to help improve human health.
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