Produção Nacional
Revisado por pares
Apical Aneurysm in Chagas Heart Disease
2021; Radiological Society of North America; Volume: 3; Issue: 5 Linguagem: Inglês
10.1148/ryct.2021210135
ISSN2638-6135
AutoresJürgen Beuther, Felipe Amorim, M Barrenechea, Eduardo Kaiser Ururahy Nunes Fonseca,
Tópico(s)Coronary Artery Anomalies
ResumoHomeRadiology: Cardiothoracic ImagingVol. 3, No. 5 Images in Cardiothoracic ImagingFree AccessApical Aneurysm in Chagas Heart DiseaseJürgen Beuther , Felipe Silva Rigaud de Amorim, Max Walter Reyes Barrenechea, Eduardo Kaiser Ururahy Nunes FonsecaJürgen Beuther , Felipe Silva Rigaud de Amorim, Max Walter Reyes Barrenechea, Eduardo Kaiser Ururahy Nunes FonsecaAuthor AffiliationsFrom the Department of Diagnostic Imaging, Universidade de São Paulo Instituto do Coração, Av Dr. Enéas Carvalho de Aguiar 44, Cerqueira César, São Paulo, SP, Brazil 05403-900.Address correspondence to J.B. (e-mail: [email protected]).Jürgen Beuther Felipe Silva Rigaud de AmorimMax Walter Reyes BarrenecheaEduardo Kaiser Ururahy Nunes FonsecaPublished Online:Sep 16 2021https://doi.org/10.1148/ryct.2021210135MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Supplemental material is available for this article.The apical aneurysm is a well-recognized and somewhat typical complication of Chagas heart disease. One should be aware that the late gadolinium enhancement (LGE) pattern may be indistinguishable from infarction. A patient’s history and lack of obstructive coronary artery disease can help in the differentiation. Imaging follow-up is important because an apical aneurysm poses increased risk for cardioembolic events.Imaging findings of Chagas disease at cardiac MRI may overlap those of ischemic cardiomyopathies, both presenting subendocardial and transmural patterns of LGE, in which the distinction cannot always be reliably made with cardiac MRI alone. Some authors believe that microvascular ischemia could play a role in the pathophysiologic mechanism of Chagas disease (1). The presence of normal coronary arteries, LGE not restricted to coronary artery territories, positive serologic findings, and compatible epidemiologic findings suggest the possibility of Chagas disease in dubious cases. Furthermore, concurrent presence of LGE in the basal inferolateral segment and apex is more frequently found in Chagas disease (1,2) (Figure).(A, B) Coronary CT angiographic and (C) cardiac MR image (Movie 1) in a 66-year-old woman with chronic Chagas disease, heart failure, and progressive dyspnea. The coronary CT angiographic images show a large apical aneurysm (apical lesion) of the left ventricle (arrowheads) but no obstructive coronary artery disease. The cardiac MR image also depicts this aneurysm (arrowheads) and apical dyskinesia (Movie 2). Late gadolinium enhancement image shows transmural enhancement of the apical segments and the true apex, without thrombus (C).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie 1: Cine cardiac MRI of the patient in two-chamber view demonstrates the exuberant apical aneurysm in correlation to the coronary CT angiographic finding.Download Original Video (.8 MB)Get the Flash Player to see this video.Movie 2: Cine cardiac MRI in four-chamber view demonstrates the exuberant apical aneurysm with dyskinesia and ventricular wall thinning.Download Original Video (3.7 MB)Disclosures of Conflicts of Interest: J.B. disclosed no relevant relationships. F.S.R.d.A. disclosed no relevant relationships. M.W.R.B. disclosed no relevant relationships. E.K.U.N.F. disclosed no relevant relationships.Keywords: CT, MR Imaging, Cardiac, Heart, Aneurysms, InfectionsAuthors declared no funding for this work.References1. Belisario Falchetto E, Costa SC, Rochitte CE. Diagnostic challenges of Chagas cardiomyopathy and CMR imaging. Glob Heart 2015;10(3):181–187. Crossref, Medline, Google Scholar2. Regueiro A, García-Álvarez A, Sitges M et al. Myocardial involvement in Chagas disease: insights from cardiac magnetic resonance. Int J Cardiol 2013;165(1):107–112. Crossref, Medline, Google ScholarArticle HistoryReceived: May 12 2021Revision requested: June 11 2021Revision received: July 13 2021Accepted: Aug 9 2021Published online: Sept 16 2021 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 3, No. 5 Metrics Altmetric Score
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