RESUMO
An 84-yr-old man with previous anterior wall myocardial infarction presented with shortness of breath and palpitations. His symptoms were attributed to myocardial ischemia, and he was referred for a stress 99mTc-sestamibi SPECT imaging study with gating. The images showed minimal left ventricular ischemia, but a dilated and hypokinetic right ventricle suggested pulmonary pathology as the probable etiology of his presenting symptoms. A subsequent ventilation perfusion study was consistent with the diagnosis of multiple pulmonary emboli. Thus, 99mTc-sestamibi SPECT imaging with gating provides information about right ventricular perfusion and function, enhancing the clinical utility of stress myocardial perfusion imaging.
Assuntos
Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Direita/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Imagem do Acúmulo Cardíaco de Comporta , Humanos , Masculino , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/etiologia , Embolia Pulmonar/fisiopatologia , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Disfunção Ventricular Direita/etiologiaRESUMO
We describe 2 patients with progressive systemic sclerosis (PSS) who manifested characteristic pathologic abnormalities in the urinary bladder. Increased connective tissue deposition in the lamina propria and between smooth muscle bundles was demonstrated in both patients and endovascular proliferation in small arteries of the bladder was noted in one patient. Both patients had persistent unexplained microscopic hematuria; one patient manifested urinary frequency and incontinence. The relationship of these clinical abnormalities to the pathologic findings in the bladder is unclear. Structural or functional abnormalities of the urinary bladder may develop in patients with PSS.
