Case Session 05: Systemic and Inflammatory Disease (2018)-Unknown systemic lupus erythematosus initially suspected by CMR.

Unknown systemic lupus erythematosus initially suspected by CMR.

Video Transcription

Video Summary

A 47-year-old woman had recurrent chest pain episodes. After a prior MI treated with PCI to a proximal LAD occlusion, she returned with atypical pain, elevated JVP, cardiomegaly, and an apparent LV aneurysm. Echocardiography suggested pseudoaneurysm, but cardiac MRI clarified a true LV aneurysm with hemorrhagic pericardial effusion, scarred myocardium, and both fresh and old thrombi. Pathology and antibody testing confirmed lupus as the underlying cause rather than atherosclerosis. Treatment was switched to rheumatologic management, and she recovered without further events. The case highlights cardiac MRI’s value in distinguishing aneurysm types, thrombus age, and inflammatory causes of MI.

Keywords

lupus

left ventricular aneurysm

cardiac MRI

myocardial infarction

pericardial effusion