Shu Yoshihara

Unusual Serial Electrocardiographic Changes which Progressed to Arrhythmogenic Right Ventricular Cardiomyopathy

Left ventricular (LV) involvement in the advanced stage of arrhythmogenic right ventricular cardiomyopathy (ARVC) is a well recognized phenomenon. T wave inversion in the lateral leads has been reported to be an electrocardiographic marker of LV involvement. Variants of ARVC that preferentially affect the left ventricle (left-dominant subtype of arrhythmogenic cardiomyopathy) have recently been recognized. We herein report a case in which an initial electrocardiogram that was similar to the left-dominant subtype of arrhythmogenic cardiomyopathy progressed to definitive ARVC over a period of 7 years. This case supports the hypothesis that LV involvement in ARVC may precede the evident onset of significant RV dysfunction.

A case of primary cardiac lymphoma: in vivo imaging and pathologic correlation

An 86-year-old woman was admitted because of heart failure. Transthoracic echocardiography demonstrated a pericardial effusion and masses occupying the right atrium. Axial non-contrast computed tomography (CT) image showed isoattenuating masses relative to the myocardium in the right atrium ( Panel A1 ). Contrast-enhanced CT revealed mildly enhancing right atrial masses with relatively homogeneous enhancement ( Panel A2 : axial …

Lethal Visceral Calcinosis in Fulminant Hypercalcemic Crisis

A previously healthy 41-year-old woman was admitted to our hospital with a 5-day history of anorexia and progressive lethargy. Laboratory findings showed hypercalcemia and renal failure. Serum calcium, phosphate and creatinine were 17.2 mg/dL (normal range 9.0-11.0 mg/dL), 10.4 mg/dL (normal range 6.0-9.0 mg/dL) and 3.8 mg/dL, respectively. Initial chest radiography and computed tomography showed mild infiltration in her bilateral peripheral lung fields (Picture 1A and B). Treatment with saline solution (total infu-

Subtraction coronary CT angiography clarifies in-stent restenosis of a three-layer stent segment

Received 24 February 2016; revision accepted for publication 11 April 2016. A 78-year-old man with chest pain receiving haemodialysis was referred for coronary computed tomography angiography (CCTA). Ten years previously, a bare metal stent (BMS) (Duraflex 3.0 × 14 mm) had been placed in his left anterior descending coronary artery (LAD). Subsequently, 3.0 × 23 mm and 3.0 × 23 mm sirolimus-eluting stents (SESs) were implanted in the LAD and second diagonal branch (D2), respectively, with a culotte stenting technique to treat in-stent restenosis (ISR) of the BMS (figure C). We performed subtraction CCTA using a 320-detector-row CT scanner (Aquilion ONE Vision Edition, Toshiba Medical Systems, Japan), whereby two CCTA datasets (with and without contrast injection) are acquired in a single breath-hold. Afterwards, the non-contrast image dataset (figure A, middle) is subtracted from the contrastenhanced CCTA study (figure A, left), thereby removing high-density materials including an implanted stent Subtraction coronary CT angiography clarifies in-stent restenosis of a three-layer stent segment

Serial electrocardiographic changes in isolated cardiac sarcoidosis

An asymptomatic 51-year-old woman was referred to our hospital because of progressive electrocardiographic abnormalities observed during annual health check-ups. A 12-lead electrocardiogram (ECG) at the first visit showed a complete right bundle branch block with ST elevation in leads V1 through V5 (Figure 1(A)). A 12-lead ECG performed 4 years previously had been normal. Serial ECGs showed gradual prolongation of QRS duration, attenuation of R wave amplitude and extension of T wave inversion in right precordial leads (Figure 1(B)). Ophthalmological and dermatological evaluation did not detect abnormal findings. Serum angiotensin-converting enzyme, lysozyme, soluble interleukin-2 receptor and troponin I levels were normal. Chest computed tomography revealed no hilar and mediastinal lymphadenopathy. Cardiac MRI showed regional dyskinesia (Figure 1(C)) and late gadolinium enhancement (Figure 1(D)) of the interventricular septum (white arrow) and right ventricular (RV) free wall (white arrowhead). Gallium-67 citrate SPECT/CT fusion imaging showed abnormal uptake in the basal interventricular septum (Figure 1(E), black arrowhead). However, gallium-67 citrate scintigraphy did not show abnormal uptake in other organs (Figure 1(F)). Selective coronary angiography showed normal coronary arteries. Endomyocardial biopsy from the RV side of the interventricular septum demonstrated noncaseating epithelioid cell granulomas (Figure 1(G), dotted diagram). A diagnosis of isolated cardiac sarcoidosis (CS) was confirmed, and she was treated with prednisolone. This case indicates non-specific ECG changes are observed earlier in the time course of disease progression of isolated CS, and slight changes in serial ECGs can be important initial diagnostic clues for an advanced CS workup.