Transient ischaemic dilatation

Case contributed by Dr Matt A. Morgan

Presentation

Chest pain

Patient Data

Age: 65-70Y
Gender: Male
Modality: Nuclear medicine

Myocardial SPECT Lexiscan images.

Full myocardial SPECT Lexiscan study

Modality: Nuclear medicine

Full study with all three orthogonal planes. There is a small, fixed apicoseptal perfusion defect as well as transient ischaemic dilatation with stress. The green arrows point to representative pairs of stress/rest images (stress on top, rest on bottom), demonstrating an increase in the size of the left ventricle with stress (TID ratio 1.34).

Myocardial SPECT Lexiscan in a different patient

Modality: Nuclear medicine

Myocardial SPECT Lexiscan (40 mCi of Tc-99m-MIBI) with gated SPECT analysis on both resting and post stress images. There is a small, mild anteroapical perfusion defect which is fully reversible. There is also transient ischaemic dilatation (ratio 1.28). Note how the left ventricular cavity is larger in stress than in rest.

Case Discussion

Transient ischaemic dilatation is a paradoxical phenomenon seen in myocardial SPECT perfusion imaging.  With severe balanced coronary artery disease, myocardial ischemia may result in apparent enlargement of the left ventricular cavity during stress. The cause of this is not entirely clear, but some speculate that it may be (at least partly) due to extensive subendocardial ischaemia.

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Case Information

rID: 31806
Case created: 29th Oct 2014
Last edited: 14th Feb 2017
System: Cardiac
Inclusion in quiz mode: Included

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