Elsevier

Canadian Journal of Cardiology

Volume 33, Issue 7, July 2017, Pages 950.e5-950.e6
Canadian Journal of Cardiology

Case Report
Large Left Ventricular Aneurysm and Multifocal Myocardial Involvement in a Patient With Systemic Sclerosis

https://doi.org/10.1016/j.cjca.2017.03.017Get rights and content

Abstract

A 43-year-old man with systemic sclerosis and chest pain had negative T waves in precordial electrocardiographic leads. The echocardiogram showed a large left ventricular apical accessory chamber. The coronary arteries were normal. Cardiac magnetic resonance imaging (MRI) showed a large fibrotic aneurysm and a small patch of midwall late enhancement in the septum. The aneurysm was surgically removed. At the 8-month follow-up, cardiac MRI showed the appearance of a new nodular lesion in the anterior wall, causing a localized wall motion abnormality. Myocardial involvement in patients with systemic sclerosis can be severe, and cardiac MRI evaluation is fundamental.

Résumé

Chez un homme de 43 ans présentant une sclérodermie généralisée et une douleur thoracique, l’électrocardiographie a mis en évidence des ondes T négatives dans les dérivations précordiales. L’échocardiogramme a révélé une grande chambre accessoire ventriculaire gauche apicale. Les artères coronaires étaient normales. L’imagerie par résonance magnétique (IRM) cardiaque a montré un grand anévrisme fibreux et une petite plage de rehaussement tardif médiomural septal. L’anévrisme a été enlevé chirurgicalement. Lors du suivi effectué au bout de 8 mois, l’IRM cardiaque a montré l’apparition d’une nouvelle lésion nodulaire dans la paroi antérieure, se traduisant par une anomalie localisée de la mobilité pariétale. L’atteinte myocardique chez les patients atteints de sclérodermie généralisée peut être grave, et l’évaluation au moyen de l’IRM cardiaque s’avère fondamentale.

Section snippets

Case Presentation

A 43-year-old man was referred to our outpatient clinic because of episodes of chest pain that had occurred 2 weeks before. He was a former smoker with mild hypertension. Five years previously he had began to experience Raynaud's phenomenon and thickening of the skin of the fingers. Antinuclear antibodies were strongly positive (1/320), both in a granular and nucleolar pattern; anti-topoisomerase 1 (Scl-70) and anti–Sjögren's syndrome–related antigen A (anti-SSA/Ro, 60 kD) antibodies were also

Acknowledgements

We thank Sergio Lanata, MD for performing the histologic analysis.

Disclosures

The authors have no conflicts of interest to disclose.

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