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A Worrisome Interventricular Septum
Journal of the American College of Cardiology © 2011 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 58, No. 24, 2011 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2011.06.069
IMAGES IN CARDIOLOGY
A Worrisome Interventricular Septum More Than Meets the Eye Sean R. Wilson, MD,* John P. Leonard, MD,† Julia T. Geyer, MD,‡ Joseph R. Osborne, MD, PHD,§ Jonathan W. Weinsaft, MD*§ New York, New York
From the *Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; †Hematology and Medical Oncology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; ‡Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York; and the §Department of Radiology, Weill Cornell Medical College, New York, New York. Manuscript received May 19, 2011; revised manuscript received June 2, 2011, accepted June 14, 2011.
A
59-year-old woman with known enteropathy-associated T-cell lymphoma (EATL) presented with weakness and malaise. An electrocardiogram demonstrated sinus tachycardia, right bundle branch block, and anterior ST-segment elevations (A). Cardiac catheterization showed patent coronary arteries (B, Online Videos 1 and 2). Echocardiography and cine cardiac magnetic resonance imaging (MRI) demonstrated asymmetric septal hypertrophy (Online Videos 3 and 4), whereas delayed-enhancement cardiac MRI tissue characterization showed patchy epicardial and mid-myocardial hyperenhancement, suggestive of hypertrophic cardiomyopathy (C). Positron emission tomography (PET) revealed marked hypermetabolic activity in the interventricular septum, corresponding to regional hyperenhancement on MRI (D). Subsequent cardiac septal biopsy (E) demonstrated infiltration by atypical lymphocytes with irregular nuclear contour and prominent nucleoli; T-cell morphology was identical to that found in patient’s prior bone marrow biopsy. EATL, an intestinal tumor of intraepithelial T lymphocytes, is a rare, aggressive disease. Whereas PET is used to stage EATL, no prior reports have documented cardiac involvement on PET or MRI. This case demonstrates the importance of integrated metabolic and tissue characterization imaging for cardiomyopathy assessment.
Vol. 58, No. 24, 2011 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2011.06.069
IMAGES IN CARDIOLOGY
A Worrisome Interventricular Septum More Than Meets the Eye Sean R. Wilson, MD,* John P. Leonard, MD,† Julia T. Geyer, MD,‡ Joseph R. Osborne, MD, PHD,§ Jonathan W. Weinsaft, MD*§ New York, New York
From the *Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; †Hematology and Medical Oncology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; ‡Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York; and the §Department of Radiology, Weill Cornell Medical College, New York, New York. Manuscript received May 19, 2011; revised manuscript received June 2, 2011, accepted June 14, 2011.
A
59-year-old woman with known enteropathy-associated T-cell lymphoma (EATL) presented with weakness and malaise. An electrocardiogram demonstrated sinus tachycardia, right bundle branch block, and anterior ST-segment elevations (A). Cardiac catheterization showed patent coronary arteries (B, Online Videos 1 and 2). Echocardiography and cine cardiac magnetic resonance imaging (MRI) demonstrated asymmetric septal hypertrophy (Online Videos 3 and 4), whereas delayed-enhancement cardiac MRI tissue characterization showed patchy epicardial and mid-myocardial hyperenhancement, suggestive of hypertrophic cardiomyopathy (C). Positron emission tomography (PET) revealed marked hypermetabolic activity in the interventricular septum, corresponding to regional hyperenhancement on MRI (D). Subsequent cardiac septal biopsy (E) demonstrated infiltration by atypical lymphocytes with irregular nuclear contour and prominent nucleoli; T-cell morphology was identical to that found in patient’s prior bone marrow biopsy. EATL, an intestinal tumor of intraepithelial T lymphocytes, is a rare, aggressive disease. Whereas PET is used to stage EATL, no prior reports have documented cardiac involvement on PET or MRI. This case demonstrates the importance of integrated metabolic and tissue characterization imaging for cardiomyopathy assessment.