CURRICULUM IN CARDIOLOGY - IMAGES

Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 126-127

Nuclear cardiology quiz

Abhishek Behera, Divya Yadav, Abhinav Singhal, Chetan Patel
Department of Nuclear Medicine, All Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Abhishek Behera
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2395-5414.191532

Question

• Patient is a 67-year-old male, known hypertensive, diabetic, nonsmoker, with no family history of heart disease
• He presented with complaints of dyspnea on exertion for the last 2 months
• He was referred for stress-rest thallium-201 myocardial perfusion single-photon emission computed tomography [Figure 1].

Figure 1: Stress thallium image. Click here to view

Answer

• Stress images demonstrate hypoperfused anteroseptal wall, septum, apex (marked with thick white arrows), and inferior wall (marked with thin white arrows). Rest images demonstrate marked improvement in all the above-mentioned perfusion defects. These findings signify stress-induced ischemia in the anteroseptal wall, septum, apex, and inferior wall [Figure 2].
• In addition, poststress planar images [Figure 3] demonstrate uptake in the lungs (marked with red arrow). Furthermore, there is transient ischemic dilation (left ventricular cavity size appearing larger on stress images compared to rest images), suggestive of subendocardial ischemia. Both these findings may be indicative of multivessel involvement.

Figure 2: Stress image (answer). Click here to view

Figure 3: Transient ischemic dilation. Click here to view