Case Author(s): Thomas Vreeland, M.D. / Tom Miller, M.D., Ph.D. , 2/8/95 . Rating: #D2, #Q4
78 year old man with heart failure
Anterior, left anterior oblique, and lateral views
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Full history/Diagnosis is available below
This 78 year-old man with congestive heart failure, atrial
fibrillation and thrombocytopenia was referred for
evaluation after an abnormal echocardiogram. Clinically,
amyloidosis was suspected; however, the serum and urine
electrophoresis were both negative for M-protein spikes.
Diffuse myocardial uptake (greater than sternum) is seen
on all three views on this Tc-99m pyrophosphate study.
Diffuse myocardial uptake (grade 3 or 4) will be seen
in 50-90% of pyrophosphate scintigrams of the heart in
patients with amyloidosis. (The grading system utilizes
activity equal to the sternum as equal to 3.)
Classic Echocardiographic findings include
(1) "Speckling" of the thickened myocardial wall
(2) Hyperechoic valve leaflets
(3) Thickened atrial septa
Multiple mucosal biopsies were negative for amyloidosis
prior to the echocardiogram and pyrophosphate scintigram.
Endomyocardial biopsy proved cardiac amyloidosis.
Major teaching point(s):
Myocardial infarction would be very unusual in this case because of the very large volume of involved myocardium.
Differential Diagnosis List
Myocarditis, pericarditis, metastatic calcification/hypercalcemia
and diffuse infiltrative diseases (i.e. hemachromatosis)
ACR Codes and Keywords:
References and General Discussion of Myocardial Imaging (Anatomic field:Heart and Great Vessels, Category:Other generalized systemic disorder)
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Case number: mi005
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