Adult cardiac cystic lymphangiectasia of the right atrium.

Cardiac lympangiectasia is a rare pathological dilation of the lymphatic channels of the heart. Diagnosis is made by pathology; however, there remains no definitive diagnostic study. There are reports of cardiac cystic lymphangiectasias in children. A case of right atrial lymphangiectasia, initially identified by echocardiography, is presented here. This is the first report of such a mass.

Ultrasound evaluation of soft tissue masses and fluid collections.

Musculoskeletal ultrasound has utility as a first-line screening modality in the evaluation of soft tissue masses. The sonographic appearances of cysts or lipomas may be sufficient to obviate the need for further imaging. For other complex cystic or solid masses, ultrasound is an inexpensive, widely available imaging modality that can evaluate lesion vascularity, guide diagnostic and therapeutic aspiration or biopsy procedures, and be used for follow-up examinations to determine response to therapeutic interventions.

Cardiac MRI documented left ventricular thrombus complicating acute Takotsubo syndrome: an uncommon dilemma.

Transient left ventricular apical hypokinesis results in a typical ampullary shape and has been described as Takotsubo cardiomyopathy (TCM). We report a case of TCM with the rare complication of left ventricular thrombus formation. Cardiac magnetic resonance imaging aided the diagnosis by characterizing the non-enhancing mass and evaluating the surrounding myocardium for scarring.

Lower extremity deep venous thrombosis: evaluation with ferumoxytol-enhanced MR imaging and dual-contrast mechanism--preliminary experience.

Institutional review board approval and informed consent were obtained for this HIPAA-compliant study, whose purpose was to prospectively evaluate the use of a dual-contrast mechanism in conjunction with an iron oxide blood pool contrast agent, ferumoxytol, to depict deep venous thrombosis (DVT). Nine patients with lower extremity DVT detected with duplex ultrasonography (US) were imaged with magnetic resonance (MR) imaging and ferumoxytol. Three techniques, including precontrast two-dimensional time-of-flight (TOF) imaging, ferumoxytol-enhanced bright-blood imaging, and ferumoxytol-enhanced dark-blood imaging, were applied. Image quality for precontrast and ferumoxytol-enhanced images was analyzed by using a four-point scale. Thrombus was depicted as a filling defect within the blood pool on bright-blood images and as bright tissue that appeared highly contrasted against a dark background on dark-blood images. Image quality of ferumoxytol-enhanced images was uniformly superior to that of precontrast TOF images (P = .007). Compared with precontrast TOF images, ferumoxytol-enhanced bright-blood images had higher contrast-to-noise ratios (CNRs) between thrombus and blood (P = .051), whereas ferumoxytol-enhanced dark-blood images showed significantly higher CNRs between thrombus and surrounding muscle (P = .008). Ferumoxytol-enhanced MR imaging can depict DVT with a dual-contrast mechanism and show the extent of thrombus.

Multifocal coronary artery myocardial bridging involving the right coronary and left anterior descending arteries detected by ECG-gated 64 slice multidetector CT coronary angiography.

Myocardial bridging is a congenital condition in which a segment of a major epicardial coronary artery has an intramyocardial course. Myocardial bridging is usually confined to a single vessel (typically the mid segment of the left anterior descending artery) and is usually asymptomatic, however, bridging may be associated with chest pain, myocardial infarction, or sudden cardiac death. While more commonly identified at autopsy, myocardial bridging is occasionally diagnosed by coronary angiography with identification of concomitant myocardial bridging involving both the left and right coronary arteries appearing to be uncommon. We present three patients presenting with atypical chest pain symptoms in whom concomitant right coronary artery and left anterior descending artery myocardial bridging was identified by ECG gated multidetector computed tomography (MDCT).

An unexpected cause of angina detected by ECG-gated cardiac computed tomography.

Until recently anomalous coronary artery anatomy was only identified either by coronary angiography, at autopsy, or during cardiac surgery. With recent developments in the area of cardiac imaging, ECG-gated cardiac computed tomography (CT) has emerged as a minimally invasive modality to delineate both coronary anatomy and pathology. We present a case of an anomalous right coronary artery origin from the ascending aorta detected by ECG-gated cardiac CT in a 47 year-old male who presented to the emergency department complaining of acute chest pain after intense exercise. Given its relatively non invasive nature, ECG-gated cardiac CT may assist in the diagnosis and management of patients with atypical chest pain in which more invasive diagnostic examinations (i.e. coronary angiography) are not warranted.

Cardiac lipoma and lipomatous hypertrophy of the interatrial septum: cardiac magnetic resonance imaging findings.

Cardiac lipomas are uncommon, usually asymptomatic benign primary tumors of the heart that may incidentally be discovered during computed tomography (CT) or magnetic resonance imaging (MRI). Although the finding of a low-attenuation mass with density similar to fat on CT is pathognomonic, the MRI appearances of fatty cardiac masses are variable depending on the sequences employed. The MRI findings of 4 patients with cardiac lipomas or lipomatous hypertrophy of the interatrial septum are presented. All patients had lesions with characteristic low-signal-intensity margins and high central signal intensity on "bright-blood" balanced gradient-echo cardiac MRI sequences with very low repetition and echo times. It is proposed that this appearance results from intravoxel phase cancellation effects occurring at the fat/tissue interface and is sufficiently characteristic to obviate the need for confirmatory CT.

Acute pulmonary schistosomiasis.

Acute pulmonary schistosomiasis occurs in non-immune hosts, particularly visitors to regions where Schistosoma species are endemic. While radiological findings of acute pulmonary schistosomiasis might resemble neoplastic or granulomatous disease, an appropriate travel history might suggest the diagnosis. With rising popularity of travel to Africa and South-East Asia, the incidence of acute pulmonary schistosomiasis can be expected to increase. We describe a case of acute pulmonary schistosomiasis occurring in an Australian returning from Lake Malawi, Sub-Saharan Africa.