0:00

So next case is pertains to

0:04

apical pathology. There's going to be four Images here that

0:07

are presented all of these images pertain to

0:10

apical pathology. The apex of the left ventricle may

0:13

be challenging to see by Echo car geography and Mr.

0:16

Is an ideal test for looking at the Apex either for

0:19

anatomy morphology of a tissue characterization this

0:22

because there's going to be four cases presented here.

0:25

And there's going to be four choices and I'd

0:28

like to match I'd like for the participants to match the case to

0:31

the correct diagnosis. This is case number a

0:34

I'm just going to spend about a couple

0:37

of seconds to maybe a minute on each on each case and

0:40

then show you four cases. So we're going to match the cardiacomodite images

0:43

the correct diagnosis. This is case a

0:47

and it has four choices either. It's apical hit CM as

0:50

Netflix end of myocarditis apical infarction thrombus

0:53

or left ventricular non-compaction. So let's do

0:56

the one at a time. This is case a

0:58

This is case a and I'd like the participants do

1:01

match them to the correct diagnosis. Is it so was

1:04

the answer left 24 and on compaction? I think

1:07

we're going to withhold the discussion till we do all the four otherwise.

1:10

I'd be giving the answers out for the others. Okay? Okay, so

1:13

that's case a and each of and it can be either of

1:16

these four.

1:17

This is case b and again the answer can be either

1:20

of these four.

1:21

So match the CMR images to the correct diagnosis once

1:24

again.

1:25

We have four choices here.

1:28

The Apex can be challenging to see by echocardiography and Mr. Is

1:31

a test of choice for looking at apical pathology either for

1:34

anatomy morphology or photicia characterization. Okay, so

1:37

we have a vote between apical ahead cm and apical non-companction.

1:40

Okay good. We're going to cut we're going to discuss all the four cases

1:43

once once we look at all of them. This is case number

1:46

c

1:48

Once again apical pathology can be either of those four.

1:52

Like the participants to take a vote on either of those four,

1:55

please. Okay. So that's KC. We

1:58

have one more case.

2:01

This case D two images here delayed enhancement images.

2:04

So once again, the answer can be apical hit cm.

2:08

Earphylic under my critis apical infarction thrombus or

2:11

left ventricle and on compaction and skin my requests

2:14

the audience to take award, please.

2:16

Delay enhancement images shown in two chamber and three chamber view here.

2:19

Okay apical infarction thrombus, okay.

2:22

So let's discuss these four questions four question

2:25

four cases here on the in this case number

2:28

D. We have a delay do we have delay enhancement images and two

2:31

chamber and three chamber plane notice the sub endocardial enhancement

2:34

in the LV apical segments involving the

2:37

anterior wall at the mid ventricular level

2:40

apical segments apical septum apical entry.

2:43

It's our apical entry wall apical cap,

2:46

and apical inferior wall. The involvement of

2:49

the Southern economy indicates that there is a infarction and

2:52

coronary artery disease is the patient with apical infarction.

2:55

The thrombus is not very

2:58

well seen but you see those dark areas that likely indicate indicate that

3:01

there's possibly thrombus to confirm that

3:04

this is thrombus we can do what's known as a thrombus sequence increase the

3:07

inversion time to 600 milliseconds The myocardium

3:10

becomes gray much grayer than

3:13

it watches here and the thrombus is much

3:16

better seen on a long TI sequence, but this is unmistically in

3:19

apical my Cardinal infarction in the LED.

3:22

Situation sub-nical enhancement involving the entry wall

3:25

apical cap and the apical inferior wall

3:28

LED infarction.

3:30

Case number c was left ventricular non-compaction notice

3:33

a hypertrophic later non-compacted myocardium, very spongy

3:36

myocardium in the LV apical segments lateral wall.

3:39

This is a patient with non-compaction to make

3:42

a definitive diagnosis of non-compaction one needs hypertrophic late

3:45

in myocardium with the ratio of non-compactor to compacted myocardium

3:48

greater than 2.3 in endically. However,

3:51

one may over diagnose the disease if only a non-compaction

3:54

ratio is used if the

3:57

left ventricle is dilated probably functioning in this case. The left particular is

4:00

dilated. There's fibrosis. It's more easy or definitive to

4:03

make the diagnosis, but nevertheless this degree of

4:06

hypertrophication is abnormal and this patient had a non-compaction.

4:11

Case number B belongs to patient with apical hypertrophic cardiomyopathy.

4:14

Henceium is a hit CM

4:17

hypertrophic cardiomapet is varied and it's phenotype. The Communist

4:20

pattern of hypertrophy is asymmetric Supple hypertrophy which

4:23

can lead to hocm or hypertrophic obstructive

4:26

cardiomyopathy other forms of hypertrophic can exist. One

4:29

of the rare forms is apical hypertrophic cardiomyopathy is

4:32

in this case the apex of the left ventricles preferentially

4:35

thickened compared to the basal segments. There's also

4:38

enhancement of the Apex indicating fibrosis risk factor

4:41

for seven chronic death in HCM. This patient has apical

4:44

hypertrophic condomyopathy specific form

4:47

of hypertrophone. They're just larger District to the Apex

4:50

has a better prognosis than the hypertrophic obstructive

4:53

variant. It's more common

4:56

in the Far Eastern countries. However, we're increasingly recognizing

4:59

it and MRI is far better than Echo for

5:02

visualizing the Apex particularly apical HCM. So if near

5:05

field Echo artifacts the Apex may not be well evaluated on

5:08

geography apical HCM is a diagnosis for case.

5:11

Be case number a this patient has thickening of

5:14

the LV Apex. But however, in this case, there is a thrombus there

5:17

and there's enhancement in the LV apical segments

5:20

in the inner layers of The myocardium the patient of the eosinophilic endometritis.

5:23

This is one of the options

5:27

Can be Associated blood eosinophilia and hyperestinublex syndromes.

5:30

We don't know entire exactly why the Apex

5:33

is preferentially involved over apical thickening fibrosis

5:36

in the inner layers of myocardium. Apical thrombus is

5:39

the features of apical sorry of esophilic

5:42

and endometriosis. So once again to recap years novelic

5:45

end of my carditis apical hypertrophic cardiomyopathy

5:48

left ventricular non-compaction apical my

5:51

accountant function 4 cases for diagnosis

5:54

for different cases all involving

5:57

the Apex better visualized on MRI than

6:00

Echo con Geography, okay.