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AJR Teaching File: Left Ventricular Mass in a Patient with Ischemic Heart Disease

Anil K. Attili1, Leandro Espinosa1 and Rolf Gebker2

1 Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, B1-132 Taubman Center /0302, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0302.
2 Department of Cardiology, German Heart Institute, Berlin, Germany.


Figure 1
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  		Fig. 1A —50-year-old man with known coronary artery disease and two prior anterior myocardial infarctions who presents with worsening dyspnea. See also Figure S1, cine loop, in supplemental data online. Two-chamber views of left ventricle in diastole and systole using balanced steady-state free precession (b-SSFP) technique on 3-T MRI scanner show apical left ventricular adherent mass isointense to myocardium (arrow, A). Apex and anterior wall of left ventricle are dyskinetic and aneurysmal. Left ventricular cavity is markedly enlarged (left ventricle end-diastolic diameter, 71 mm), and its function is impaired (i.e., ejection fraction of 35%).

 

Figure 2
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  		Fig. 1B —50-year-old man with known coronary artery disease and two prior anterior myocardial infarctions who presents with worsening dyspnea. See also Figure S1, cine loop, in supplemental data online. Two-chamber views of left ventricle in diastole and systole using balanced steady-state free precession (b-SSFP) technique on 3-T MRI scanner show apical left ventricular adherent mass isointense to myocardium (arrow, A). Apex and anterior wall of left ventricle are dyskinetic and aneurysmal. Left ventricular cavity is markedly enlarged (left ventricle end-diastolic diameter, 71 mm), and its function is impaired (i.e., ejection fraction of 35%).

 

Figure 3
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  		Fig. 1C —50-year-old man with known coronary artery disease and two prior anterior myocardial infarctions who presents with worsening dyspnea. See also Figure S1, cine loop, in supplemental data online. Three-chamber views of left ventricle in diastole and systole using b-SSFP technique on 3-T MRI scanner show apical left ventricular adherent mass is isointense to myocardium (arrow, C). Apex of left ventricle is dyskinetic and aneurysmal.

 

Figure 4
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  		Fig. 1D —50-year-old man with known coronary artery disease and two prior anterior myocardial infarctions who presents with worsening dyspnea. See also Figure S1, cine loop, in supplemental data online. Three-chamber views of left ventricle in diastole and systole using b-SSFP technique on 3-T MRI scanner show apical left ventricular adherent mass is isointense to myocardium (arrow, C). Apex of left ventricle is dyskinetic and aneurysmal.

 

Figure 5
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  		Fig. 1E —50-year-old man with known coronary artery disease and two prior anterior myocardial infarctions who presents with worsening dyspnea. See also Figure S1, cine loop, in supplemental data online. Contrast-enhanced delayed inversion recovery images show left ventricle in two-chamber and three-chamber views. Note transmural enhancement of apex and anterior septal wall, indicative of myocardial infarction or scar. Adherent apical mass (arrow) representing thrombus is dark and nonenhancing.

 

Figure 6
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  		Fig. 1F —50-year-old man with known coronary artery disease and two prior anterior myocardial infarctions who presents with worsening dyspnea. See also Figure S1, cine loop, in supplemental data online. Contrast-enhanced delayed inversion recovery images show left ventricle in two-chamber and three-chamber views. Note transmural enhancement of apex and anterior septal wall, indicative of myocardial infarction or scar. Adherent apical mass (arrow) representing thrombus is dark and nonenhancing.

 

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