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INTRODUCTION: In patients with ST elevation myocardial infarction (STEMI), minimizing the reperfusion time is the goal of therapy worldwide. However, the differential diagnosis is critical and when a patient is encountered with chest pain and ST elevation, STEMI should not be the only diagnosis considered. By detailed history and focused physical examination, it is possible to avoid a mistaken diagnosis. CASE PRESENTATION: In this report, we present a case of a male patient with tongue cancer and accompanying myocardial metastasis that causes electrocardiographic changes, who was initially misdiagnosed with ST elevation myocardial infarction. CONCLUSION: Here, we reported a case of metastatic cancer in the heart which was initially diagnosed as acute myocardial infarction. Echocardiography, computed tomography and magnetic resonance imaging of the heart were used accordingly to confirm the myocardial metastasis.
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INTRODUCTION: Cerebral small vessel disease (CSVD) and multiple sclerosis (MS) both harbor multiple, T2-hyperintense white matter lesions on conventional magnetic resonance imaging (MRI).We aimed to determine the microstructural changes via diffusion-weighted imaging (DWI) in normal appearing thalami. We hypothesized that the apparent diffusion coefficient (ADC) values would be different in CSVD and MS, since the extent of arterial involvement is different in these two diseases. METHODS: DWI was performed for 50 patients with CSVD and 35 patients with MS along with gender- and age-matched controls whose conventional MRI revealed normal findings. DWI was done with 1.5 Tesla MR devices using echo planar imaging (EPI) for b = 0, 1000 s/mm(2). ADC values were obtained from the thalami which appeared normal on T2-weighted and FLAIR images. Standard oval regions of interest (ROIs) of 0.5 cm(2) which were oriented parallel to the long axis of the thalamus were used for this purpose. RESULTS: The mean ADC value of the thalamus was (0.99 ± 0.16) × 10(-3) mm(2)/s in patients with CSVD, whereas the mean ADC value was (0.78 ± 0.06) × 10(-3) mm(2)/s in the control group. The mean ADC value was significantly higher in patients with CSVD compared to the controls (p < 0.001). The mean ADC values of the thalamus were (0.78 ± 0.08) × 10(-3) mm(2)/s in MS patients, and (0.75 ± 0.08) × 10(-3) mm(2)/s in the control group, which are not significantly different (p > 0.05). CONCLUSION: Our study revealed a difference in the diffusion of the thalami between CSVD and MS. DWI may aid in the radiological disease differentiation.
