ABSTRACT
Diffuse alveolar hemorrhage (DAH) is a severe and potentially life-threatening disease manifestation. In addition to autoimmune diseases such as antineutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane syndrome, pulmonary viral infections are known to be culprits of DAH. Health-care providers worldwide in the coronavirus disease 2019 pandemic have been confronted with an unprecedented number of viral lung infections, with great variance in symptoms and severity. Hemoptysis, the key symptom of DAH, is a rare complication. We present two cases of immunocompromised patients with rapidly developing hypoxemic respiratory failure and evidence of DAH in the context of severe acute respiratory syndrome coronavirus 2 infection.
Subject(s)
Coronavirus Infections/complications , Hemorrhage/etiology , Immunocompromised Host , Lung Diseases/etiology , Pneumonia, Viral/complications , Aged , Aortitis/complications , Aortitis/drug therapy , Aortitis/immunology , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Autoimmune Diseases/immunology , Betacoronavirus , COVID-19 , Carcinoma, Transitional Cell/complications , Carcinoma, Transitional Cell/immunology , Carcinoma, Transitional Cell/therapy , Chemoradiotherapy , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Cross Infection , Glucocorticoids/therapeutic use , Hemoptysis/etiology , Humans , Hypereosinophilic Syndrome/complications , Hypereosinophilic Syndrome/drug therapy , Hypereosinophilic Syndrome/immunology , Hypoxia/physiopathology , Immunosuppressive Agents/therapeutic use , Male , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Prednisolone/therapeutic use , Respiratory Insufficiency/physiopathology , SARS-CoV-2 , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/therapyABSTRACT
INTRODUCTION: Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) are important differential diagnosis of left ventricular hypertrophy. The aim of this study was to investigate if three-dimensional (3D) speckle tracking-derived functional parameters enabled differentiation of CA and HCM by a disease-specific pattern. METHODS: Twelve patients with CA and 12 patients with HCM were included. CA and HCM were diagnosed by contrast-enhanced cardiovascular magnetic resonance (CMR). Three-dimensional speckle tracking echocardiography with wall motion analysis was performed for strain (radial [RS(%)], longitudinal [LS (-%)], and circumferential [CS (-%)]), rotation (ROT [degree]), and twist (TWT [degree]). Intergroup comparison included normalized values from 49 healthy volunteers. RESULTS: Averaged RS, LS, CS, ROT, and TWT were investigated at basal, midventricular, and apical levels. With some exceptions, 3D speckle tracking function parameters were mostly lower in the HCM and minimal in the CA group as compared to controls. Comparing CA and HCM, basal RS was significantly reduced in patients with amyloidosis (7.5 ± 19.7 vs. 22.3 ± 22.7; P < 0.0001), furthermore the "physiological" gradient of basoapically decreasing RS, which was reduced, but still preserved in HCM, showed a clear "inverse pattern" in patients with amyloidosis, comprising a gradual increase from base to apex. Correlation analysis of 3D speckle tracking function and CMR late gadolinium enhancement (LGE) revealed high inverse correlation of RS and LGE in CA (r =-0.82) and only mild correlation in HCM, followed by CS as second best parameter. An increasing/decreasing basoapical RS gradient yielded a sensitivity of 83% versus the CMR-derived diagnosis "CA" and "HCM." CONCLUSIONS: Three-dimensional speckle tracking echocardiography demonstrated significant differences in CA and HCM. The basoapical RS gradient displayed oppositional characteristics in CA and HCM, suggesting a "function-pattern-based" differentiation of amyloidosis and HCM.
Subject(s)
Amyloidosis/diagnostic imaging , Cardiomyopathy, Hypertrophic/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Elasticity Imaging Techniques/methods , Heart Diseases/diagnostic imaging , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Cardiac injury occasionally occurs as a result of blunt chest trauma. Most cardiac complications in chest trauma are due to myocardial contusion rather than direct damage to the coronary arteries. However, traumatic coronary injury has been reported, and a variety of underlying pathophysiological mechanisms have been proposed. We present a 26 year old patient presenting with an acute coronary syndrome as a consequence of a soccer-shot impact to the chest. CMR showed apical inferior infarction, as well as multiple small septal lesions which were presumed to have resulted from embolization. The culprit lesion was a proximal 75% LAD stenosis with a prominent plaque-rupture and thrombus-formation, and the distal LAD was occluded by thromboembolic material.
Subject(s)
Acute Coronary Syndrome/diagnosis , Coronary Stenosis/diagnosis , Coronary Thrombosis/diagnosis , Heart Injuries/complications , Magnetic Resonance Imaging, Cine , Myocardial Infarction/diagnosis , Soccer/injuries , Thromboembolism/diagnosis , Wounds, Nonpenetrating/complications , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/therapy , Adult , Angioplasty/instrumentation , Coronary Angiography , Coronary Stenosis/etiology , Coronary Stenosis/therapy , Coronary Thrombosis/etiology , Coronary Thrombosis/therapy , Electrocardiography , Heart Injuries/pathology , Heart Injuries/therapy , Humans , Male , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Myocardium/pathology , Severity of Illness Index , Stents , Thromboembolism/etiology , Thromboembolism/therapy , Treatment Outcome , Wounds, Nonpenetrating/pathology , Wounds, Nonpenetrating/therapyABSTRACT
Using real-time 3D-speckle-tracking in the clinical course of Tako-Tsubo turned out as a quick and feasible tool for recognition and follow-up of wall motion abnormalities.
