Idiopathic massive myocardial calcification: a case report and review of the literature.

We report a rare case of massive myocardial calcification in a 42-year-old male who presented with symptoms of congestive heart failure and arrhythmia. Myocardial calcification is most commonly associated with myocardial infarction or, less commonly, hypercalcemia. This case is particularly unusual due to the lack of any known predisposing risk factors, including normal coronary arteries, normal renal function, and normal serum calcium levels. Alternative etiologies are discussed accompanied by a review of the literature.

Nephrogenic systemic fibrosis versus contrast-induced nephropathy: risks and benefits of contrast-enhanced MR and CT in renally impaired patients.

Magnetic resonance imaging (MRI) and computed tomography (CT) have become essential to diagnostic evaluation of many, or most, important medically and surgically treated diseases. It is important to consider comprehensively the implications in making decisions when choosing one or the other cross-sectional imaging modality. Factors to consider include the relative risks of the contrast agent. Other factors include the relative procedural risks, including radiation risks and the relative expected diagnostic yield of the examination technique (12). In this review we describe both nephrogenic systemic fibrosis and contrast-induced nephropathy to compare the implications with regard to relative risks and benefits of contrast-enhanced MRI or CT in patients with impaired renal function. J. Magn. Reson. Imaging 2009;30:1350-1356. (c) 2009 Wiley-Liss, Inc.

Preoperative evaluation of potential living related kidney donors with high-spatial-resolution magnetic resonance (MR) angiography at 3 Tesla: comparison with intraoperative findings.

PURPOSE: The purpose of this prospective study was to determine the feasibility and accuracy of high-spatial-resolution MR imaging at 3 Tesla (T) in the preoperative evaluation of potential living related kidney donors. MATERIALS AND METHODS: Eighteen potential donors (8 men, 10 women; mean age, 50.1 +/- 14.2 years) for renal transplantation were evaluated with 3 T MR imaging. A high-spatial-resolution 3-dimensional (3D) gradient-echo MR angiography (repetition time/echo time, 3.0/1.14 ms; flip, 19-23 degrees; matrix, 512; slice thickness, 1.0 mm) using parallel acquisition technique (GRAPPA) with an acceleration factor of 3 was performed on a whole body scanner. Images were evaluated in a prospective and blinded fashion by 2 MR radiologists. The number of renal arteries, presence of early branches (defined as a branch arising within 2 cm of the main renal ostium), and renal artery stenosis were analyzed. The renal parenchyma, collecting system and ureters, were evaluated on the MR urograms. Interpretation of MR images were compared with surgical findings. RESULTS: Based on MR angiography data sets, a total of 36 main and 9 accessory renal arteries was found. There were 5 renal arteries presenting an early branching (

Recent experience with open repair of pectus excavatum with minimal cartilage resection.

HYPOTHESIS: Inconsistent results have been reported using a variety of open surgical techniques to correct pectus excavatum (PE) deformities with subperiosteal resection of deformed costal cartilages. DESIGN: Retrospective 6-year review of 450 consecutive patients undergoing PE repair. SETTING: Tertiary care academic medical center. PATIENTS: Symptomatic patients with severe PE (severity index >3.4). INTERVENTION: Evaluation of open repair with minimal cartilage resection, suture reattachment of costal cartilages to the sternum and ribs, and internal support strut for 6 months. MAIN OUTCOME MEASURES: Age at repair, severity index, reduction of symptoms, complications, recurrence, and mortality. RESULTS: Nine percent of patients were younger than 12 years at repair, 42% were aged 12 to 17 years, 33% were aged 18 to 30 years, and 16% were older than 30 years. Nineteen percent were female. Mean +/- SD severity index was 4.88 +/- 1.8. Mean hospital stay was 2.9 days. No patients received epidural analgesics. Complications occurred in 2.6% of patients and included idiopathic ventricular arrhythmia (2 patients), transient pericarditis (2 patients), pleural effusion (3 patients), dislodged sternal bar (2 patients), hematoma (1 patient), seroma (1 patient), and localized infection (1 patient). Mild recurrence occurred in 4 patients, and 9 patients had resection of localized cartilage protrusion when the bar was removed. There were no deaths. Ninety-eight percent of patients reported very good to excellent results. All patients reported improvement in symptoms. Mean follow-up was 26 months after strut removal. CONCLUSION: In this largest, to our knowledge, recently reported series of openly repaired PE using minimal cartilage resection and suture reattachment of the costal cartilages to the sternum and ribs, advantages included short operative time, stable early postoperative chest wall, few complications, mild pain, good physiologic and cosmetic results, and effectiveness for all variations of PE in patients of all ages.

Non-invasive cardiac evaluation in heart failure patients using magnetic resonance imaging: a feasibility study.

BACKGROUND: To assess the feasibility of a fast, flow-insensitive magnetic resonance imaging (MRI) protocol in heart failure patients for the evaluation of cardiac function, cardiovascular anatomy, and myocardial viability. METHODS AND RESULTS: Thirty-two consecutive patients with left ventricular (LV) systolic dysfunction and 13 control subjects were prospectively evaluated with MRI. The exam consisted of cine imaging with a steady-state free precession sequence, followed by time-resolved, three-dimensional angiography and delayed, contrast-enhanced imaging. Multiple LV parameters were evaluated, and the heart failure and control results were compared. In 12 patients, MRI-determined ejection fractions were compared to echocardiographic values. Additionally, a qualitative analysis of the cine images was performed. The cardiac MR evaluation yielded diagnostic-quality images in all subjects. Mean imaging time was 37 min. MRI demonstrated significant differences between the heart failure and control subjects in all parameters assessed (p < 0.05). MRI-determined ejection fractions correlated strongly with echocardiographic values (R = 0.75), although the limits of agreement were wide (-17.3%-18.3%). CONCLUSIONS: Using fast, flow-insensitive imaging techniques, MRI is feasible in heart failure for the derivation of more independent indices of cardiac status than any other non-invasive test. Although further investigation is warranted, MRI may prove uniquely helpful in heart failure diagnosis and management.