Cardiac amyloidosis

Case contributed by Dr Ben Hudson

Presentation

History of breathlessness. Echocardiogram requested and abnormal. Also previous hip arthroplasty and bone scan performed contemporaneously to assess for loosening.

Patient Data

Age: 80 years
Gender: Female

Cardiac MRI

mri

CINE IMAGES

  • markedly increased wall thickness: left ventricle (LV) 20 mm; right ventricle (RV) 6 mm
  • asymmetric increase in LV wall thickness most markedly affecting the septal segments, and more so the basal and mid cavity
  • overall mildly impaired LV systolic function
  • severely impaired mitral annular plane systolic excursion (MAPSE) and mildly impaired tricuspid annular plane systolic excursion (TAPSE)
  • moderately dilated left atrial area
  • small pericardial effusion

LATE GADOLINIUM ENHANCED IMAGES

  • abnormal coincident nulling of the blood pool and myocardium
  • diffuse transmural late gadolinium enhancement of the LV, RV, and right atrium
  • rapid clearance of gadolinium from the blood pool

Tc99m HDP Bone Scan

Nuclear medicine
  • abnormal tracer (HDP) uptake in the heart
  • linear uptake right lateral chest wall, in keeping with previous trauma

Case Discussion

This case demonstrates the cardiac MRI and incidental Tc99m HDP bone scan findings of a patient with cardiac amyloidosis.

The distribution and florid nature of the late gadolinium enhancement, along with the tracer uptake on bone scan and clinical course, are in keeping with ATTR subtype of cardiac amyloidosis.

These findings are characteristic of cardiac amyloidosis, and the differential in this particular case is very limited.

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