Case of the week

1
Case of the week 08-19 Diagnosing RV
dilatation by CMR
History A 52 year old male with a dilated right
ventricle and elevated pulmonary artery pressures
on echocardiography. CMR Findings Dilated right
ventricle (EDV 179ml/sqm) and right atrium.
Dilated main pulmonary artery. No ASD detected,
but anomalous pulmonary venous connections of the
entire right lung to the SVC and right atrium
(A). No Scimitar syndrome, no sinus venosus ASD.
Normal pulmonary venous connections of the left
lung to the left atrium. Qp/Qs 2.41 CMR Points
In RV dilatation, CMR is of great utility. It
can Assess function and RV cardiomyopathy Assess
QpQs, in this case showing volume
overload. Identify intracardiac shunts Identify
extracardiac shunts, in this case PAPVD CMR can
be considered a non-invasive alternative to
cardiac catheterization in this group of
patients. If, as a CMR practionner, a patient
is referred for CMR as "?ARVC", and there is RV
dilatation, consider the possibility of a shunt
and systematically exclude or search for
it. Outcome The patient underwent an uneventful
surgical repair accomplished by creating an ASD
and then constructing an intra-atrial baffle from
the anomalous pulmonary veins through the ASD to
the left atrium.
A
F
Ferrari VA, Scott CH, Holland GA, Axel L, St.
John Sutton M Ultrafast three-dimensional
contrast-enhanced MRA and imaging in the
diagnosis of partial anomalous pulmonary venous
drainage. JACC 2001371120-8. (full text) Prasad
SK, Soukias N, Hornung T, Khan M, Pennell DJ,
Gatzoulis MA, Mohiaddin RM. Role of MRA in the
Diagnosis of Major Aortopulmonary Collateral
Arteries and Partial Anomalous Pulmonary Venous
Drainage. Circulation. 2004109207-214 (full
text)
B
C
Sivan Lieberman, Anil K Attili, Adam L
DorfmanUniversity of Michigan