PMC2291324_01
Angiogram of the left coronary artery. The left anterior descending coronary artery (LAD) is distally occluded (arrow in A); after intracoronary application of nitroglycerine the LAD is open (arrows in B), but demonstrating a long, severely diseased coronary segment that is significantly stenosed. Because of the long coronary segment involved, the small diameter and the suspicion of inflammatory origin of the stenosis, percutaneous coronary intervention was not attempted.
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Coronary angiography revealed a distally occluded left anterior descending coronary artery (Figure 1A), the occlusion being reversible after nitroglycerine (Figure 1B).
Magnetic resonance imaging of the left ventricle. Phase sensitive T1-weighted contrast based late enhancement sequence (PSIR). A subendocardial bandlinke hyperintensity in the interventricular septum was found in the four chamber view and short axis orientation (arrow). A small pericardial effusion was present.
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A bandlike subendocardial hyperintensity was detected in the interventricular septum (Figure 2A). After 4 and 12-months, small areas of late enhancement persisted in the apical septum on MRI with regional hypokinesia in this region (Figure 2B, 2C).
Follow-up after four months. Subendocardial late enhancement persisted, though smaller in extension as seen in this PSIR late enhancement image of the four chamber view and short axis orientation. No pericardial effusion.
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Symptoms, eosinophilia, IgE count, Troponin T- and CK levels decreased to normal ranges (Figure 3).