0:00

Case number 19 shows Once

0:03

Again has four different cases and they can

0:06

be either of the four at like the polling

0:09

questions to be open to be shown again, please all these

0:12

are four cases are delayed enhancement images. There's four different

0:15

patterns of delayed enhancement. This is case a

0:19

but I'm going to show all the four cases and will come back to the questions.

0:23

case a

0:25

case b just a brief history here case

0:28

b is a young man who presented a chest pain?

0:32

case C history without in this

0:35

particular case and finally case d

0:39

case d

0:42

c

0:43

b and a will start with

0:46

a based on this delayed enhancement pattern.

0:50

Which of the following diagnosis is most likely the four

0:53

Choice say they might call in function chronic amylidosis myocarditis

0:56

or cardiac sarcoidosis myocardial

0:59

infarction for case a unfortunately that's not correct

1:02

this patient

1:05

to the abnormalities here are an unusually dark

1:08

appearance the blood pool. It's difficult to null The myocardium notice

1:11

that this diffuse enhancement in the separate region. This patient

1:14

has cardiac amylidosis and the Clues here

1:17

are an unusually dark blood pool difficulty nulling

1:20

The myocardium and somewhat patchy enhancement

1:23

throughout the lb myocardium particularly the

1:26

basal sample region notice that there's almost sub-accal enhancement in certain

1:29

areas of the heart as in the apical regions.

1:32

Mid ventricular region some parts of the papery muscles

1:35

enhancing this patient had cardiac amylidosis

1:38

difficulty nulling The myocardium unusually dark

1:41

appearance of the blood pool patient enhancement in regions

1:44

of The myocardium Global subtle enhancement. Now the areas features of

1:47

cardiac amylidosis

1:49

Okay case number B. One of the following four choices is possible again.

1:52

Can we have the polygen please? My Carl infarction amyloidosis

1:55

micronitis and cardiac sacredosis.

1:58

and the correct answer is

2:00

Myocarditis excellent notice that this sub-epica enhancement

2:03

the lateral wall of the left ventricular as opposed to

2:06

sub in the Cardinal announcement. The sub-in economies involved in

2:09

ishkemia and coronary artery disease, whereas non-submedical areas

2:12

particularly. The sub epicardium is

2:15

enrolled in myocarditis involved into the lateral wall. The subway

2:18

be kind of distribution is typical for myocarditis typically

2:21

Indian patients and prison, which has been in normal coronary arteries diagnosis and

2:24

acute microtitis Okay Casey can

2:27

we have the polling questions again? Fresh means? Okay my

2:30

collection, excellent. There's transmiral enhancement

2:33

and it enrolls the endocybendercardium in the apical

2:36

segments of the heart typical LED distribution entry wall

2:39

starting for the mid ventricular region to the Apex mid

2:42

and distal LED distribution apical Cape apical inferior

2:45

wall patient has excuse me. I think

2:48

I share the wrong screen patient has in my Carlin Fox

2:51

and the LED distribution apical mind Carlin function suburcado involvement

2:54

transmiral enhancement non-viable my

2:57

accountant function.

2:59

Case number D. Can we take a poll again, please? Okay, there's

3:02

one remaining diagnosis here.

3:05

This is a patient presented with complete atrioventricular

3:08

block.

3:10

Cardiacode is excellent patchy enhancement throughout the

3:13

left ventricle in a non-ishchemic distribution involve into

3:16

the basal septum particularly on the right ventricular side. Non-ishly pattern

3:19

of enhancement patchy involves a

3:22

basal septum typical findings of cardiac sacredosis. So

3:25

once again, let's recap cardiac sarcoidosis nanish chemic

3:28

passion of enhancement is also RV enhancement in this

3:31

in this particular case patch here is of enhancement including environmental

3:34

basil snapchatosis transmiral

3:37

enhancement involving

3:40

the subway according to coronary artery distribution this case the

3:43

LED my Carlin foxion sub apical

3:46

enhancement in the lateral wall of the left rancherical my contacts

3:49

diffuse enhancement or inability unusually donkey

3:53

praying for the blood pool patchy enhancement of the Samson Global

3:56

subbanon Huntsman and other areas of heart chronic and amoledosis. So

4:00

four different conditions, the etiology

4:03

of cardiomyopathies and heart failure can be identified very

4:06

well by cardiac amelitosis depending on the delay enhancement

4:09

pattern as

4:10

Be shown in these four cases.