Case 24

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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Case 24

A 76-year-old male with known CAD and prior myocardial infarction was admitted to the hospital with worsening heart failure. He was referred for rest-redistribution thallium-201 (²⁰¹Tl) imaging for the detection of myocardial viability. An injection of 3.3 mCi of ²⁰¹Tl was given intravenously at rest, and this was followed by gated SPECT imaging 15 minutes and 4 hours later. The images are shown next. What is your interpretation?

(Fig. 1)

Atrial fibrillation with intermittent BiV paced beats. There are Q waves noted in inferior leads and V6 in the nonpaced beats.

(Video 1a)

(Video 1b)

(Fig. 2a)

(Fig. 2b)

(Fig. 2c)

(Video 2)

The left ventricle is enlarged, and there is a large area of perfusion abnormality involving the inferior and lateral walls, which does not show any reversibility on the delayed images. There is evidence of reverse redistribution in these areas of perfusion abnormality. There is global hypokinesia of the left ventricle, and left ventricular ejection fraction is severely impaired at 24%. The right ventricle is also massively enlarged and severely hypokinetic. There is increased lung thallium uptake. However, importantly, there is a very large pleural effusion on the right side. It is likely that this effusion is contributing substantially to the patient’s symptoms.

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