PMC9273878_01
Imaging findings of eosinophilic granulomatosis with polyangiitis (A-D,H) Imaging findings during the initial hospitalization (A,D, coronal view; B,C,H, transverse view). Multiple patchy consolidations of both lungs (A,B, triangular arrows) on CMR images, multiple acute cerebral infarctions (C, triangular arrows) with no obvious cerebrovascular stenosis (H, triangular arrows) on brain MR images and sinusitis and nasal polyps (D, triangular arrows) on reconstructed CT images. (E-G) Imaging findings during the subsequent hospitalization (E, coronal view; F,G, transverse view). Significantly absorbed multiple lesions of both lungs (E,F), the pulmonary hypertension with increased diameters of pulmonary trunk from 28 mm (B) to 32 mm (F) and multiple encephalomalacia (G, long arrows).
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F1
The patient presented with a 10-year history of asthma, sinusitis, and nasal polyps (Figure 1D). Diffusion-weighted imaging of the brain magnetic resonance imaging (MRI) revealed multiple acute cerebral infarctions (Figure 1C) with no obvious cerebrovascular stenosis on magnetic resonance angiography (MRA) (Figure 1H). Chest CT and Cardiac magnetic resonance (CMR) localizing images showed multiple patchy consolidations of both lungs and bilateral pleural effusion (Figures 1A,B). CMR imaging was performed again, showing enlargement of RA and RV (Table 2, Figure 2J, Supplementary Videos 9-12), significantly improved endocardial enhancement and overlying thrombus on cine, perfusion and LGE images (Figures 2G-L, Supplementary Videos 7-12), remarkably reduced RV systolic function but improvement of LV systolic function (Table 2, Supplementary Videos 7-10), new strip-like LGE in the lateral wall (Figure 2L), representing replacement fibrosis and increased diameters of pulmonary trunk from 28 mm to 32 mm (Figures 1B,F). Multiple lesions of both lungs were significantly absorbed (Figures 1E,F) and encephalomalacia were formed (Figure 1G).
Comparison of cardiovascular involvement detected by CMR during two separate hospitalizations (A-F) CMR findings during the initial hospitalization (A-C, short-axis view; D-F, four-chamber view). Distinct high-signal-intensity plane separating the thrombus from underlying myocardium on end-diastolic cine images (A,D, triangular arrows), endocardial surface hypoperfusion zone on perfusion images (B,E, triangular arrows) and endocardial enhancement and overlying non-enhancing thrombus on LGE images (C,F, triangular arrows). (G-L) CMR findings during the subsequent hospitalization (G-I, short-axis view; J-L, four-chamber view). Enlargement of right atrium and right ventricle, flat ventricular septum (G,J, long arrows) and significantly reduced high-signal-intensity plane and thrombus (G,J, triangular arrows) on cine images, significantly reduced endocardial surface hypoperfusion zone on perfusion images (H,K, triangular arrows) and significantly thinning endocardial enhancement and overlying thrombus (I,L, triangular arrows), new strip-like LGE in the lateral wall (L, long arrows) on LGE images, representing replacement fibrosis.
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F2
CMR imaging was performed again, showing enlargement of RA and RV (Table 2, Figure 2J, Supplementary Videos 9-12), significantly improved endocardial enhancement and overlying thrombus on cine, perfusion and LGE images (Figures 2G-L, Supplementary Videos 7-12), remarkably reduced RV systolic function but improvement of LV systolic function (Table 2, Supplementary Videos 7-10), new strip-like LGE in the lateral wall (Figure 2L), representing replacement fibrosis and increased diameters of pulmonary trunk from 28 mm to 32 mm (Figures 1B,F).