0:00

And so then the last case is a 58 year old

0:03

woman who presents for evaluation of a large right? Atrial Mass

0:06

on an echocardiography. So these are two kind

0:09

of localizer. Hay sequences that

0:12

were performed at the cardiac MRI. So axial and coronal

0:16

And we can see that they have this kind of like Mass lights thickening

0:19

here involving the interracial septum kind

0:22

of extending into the free wall the right atrium.

0:25

We have this image here, which is kind of

0:28

situated at the aortic valve. You can see this mass-like thickening

0:31

here of the inter atrial septum. And then on the

0:34

four chamber view, you can see this thickening here which kind

0:37

of extends into this free wall of the right atrium.

0:41

These are going to be black blood sequences

0:44

before and after this one

0:47

on the bottom has that saturation. The

0:50

one on the top does not have fat saturation. You can see

0:53

that this mass is very similar in Signal intensity to subcutaneous

0:56

fat and on the fat set contrast image.

0:59

You didn't actually seeing enhancement and it's

1:02

fat-sided out.

1:04

And so what is the most likely diagnosis for this case that makes

1:07

Soma and angiosarcoma metastasis or

1:10

other?

1:16

So the correct answer here is other.

1:20

And this is a CT image from the same patient here.

1:23

You can see this large fat containing, Mass.

1:27

It's involving mainly the interracial septum,

1:30

but also extending out into the free wall the right atrium. This

1:33

is an example of like pulmonocytechertrophy of

1:36

the intratrial septum. So occasionally in this game may be mistaken

1:39

at echocardiography for a right atrial, Mass.

1:43

This is a companion case. This is kind of why it's important to know

1:46

what this is. You can see on pet. You have

1:49

the same fat thickening of the interracial septum.

1:52

That's actually fpg Avid. And so what makes this

1:55

lesion sdg Avid on pet study

1:58

So the malignant cells infection ground fat or

2:01

fdg extravization.

2:05

So the correct answer is here that like Pullman of hypertrophy may

2:08

contain Brown fat and that's why it's important to realize

2:11

what this is because this can inadvertently

2:14

lead to upstaging with someone's malignancy if

2:17

you aren't aware of this phenomenon at Pete

2:21

So I promise hypertrophy of intraco septum. It's

2:24

more frequently seen in the elderly and obese population

2:27

or in patients who have a large amount of epicardial or

2:30

mediastinal fat. It may

2:33

have brown fat within it and maybe sdg Avid and it

2:36

may be mistaken for a master thrombus on echocardiography.

2:40

So in summary when you're kind of looking at these cardiac MRI

2:43

cases, look at the cine Clips to determine wall motion

2:46

try to assess Global and Regional motion abnormality.

2:49

We'll get the anatomy the overall function of

2:52

the ventricle is the wall too thin too thick

2:55

is it focal or diffuse? And then finally are there any valve after

2:58

maltes and valves are really kind of manifested by

3:01

that spendy phasing or turbulent flow artifact that

3:04

we saw review the double in the triple IR sequences for

3:07

any past characteristics as well as edema as

3:10

we saw in the myocarditis case then try when you're

3:13

looking at the lake edelenium enhanced sequences. Those are going to be one of

3:16

the more important sequences on MRI.

3:18

Try to separate the pattern into ischemic and

3:21

non-ischemic patterns. Remember the four most

3:24

common non-ischemic patterns are going to be sarcoid amyloid.

3:28

myocarditis and then hypertrophic cardiomyopathy

3:32

and so ischemic versus non-ischemic to

3:35

try to separate it out in one of those two groups. They're really

3:38

narrow your differential diagnosis, and I

3:41

think you all for your attention.