Case Session 04: Miscellaneous (2018)-The use of CMR in diagnosing and quantifying an unusual extracardiac shunt

The use of CMR in diagnosing and quantifying an unusual extracardiac shunt

Video Transcription

Video Summary

A 33-year-old previously healthy woman presented with nocturnal dyspnea, cough, and a continuous murmur. Imaging revealed a large, highly vascular right upper lobe mass with lymphadenopathy. Bronchoscopy and immunohistochemistry confirmed primary Hodgkin’s lymphoma. Cardiac MRI was used to assess lesion vascularity and quantify shunt physiology, showing a Qp/Qs of 0.79, consistent with PDA-like physiology. After six cycles of ABVD chemotherapy, PET imaging showed complete metabolic resolution and the continuous murmur nearly disappeared. The case highlights cardiac MRI as a useful, non-invasive tool for evaluating tumor vascularity, shunt quantification, and ventricular volume overload.

Keywords

Hodgkin’s lymphoma

cardiac MRI

PDA-like physiology

continuous murmur

ABVD chemotherapy