PMC5564183_01
12-lead EKG manifestation of anterolateral ischemia as lateral lead T-wave inversion without ST-segment elevation.
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fig1
EKG showed lateral lead T-wave inversion without ST-segment elevation (Figure 1), consistent with a NSTEMI.
(a) Axial coronary computed tomography angiogram (CCTA), (b) echocardiogram, and (c) CMR with delayed myocardial enhancement images demonstrate marked asymmetric thickening of the lateral left ventricular wall (arrows). There is obliteration of left ventricular pericardial fat on CCTA. (d) Axial and (e) curviplanar reformatted CT images of the left circumflex artery (LCx) show abnormal soft tissue in the left atrioventricular groove (arrowheads) resulting in approximately 50% stenosis of the LCx immediately after the takeoff of the first obtuse marginal branch. (f) Bone marrow biopsy slide demonstrates replacement of normal hematopoietic elements by small lymphoblasts comprising approximately 50% of total cellularity, compatible with leukemia recurrence.
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fig2
A CCTA showed calcium-free coronary arteries; however, there was extensive soft tissue infiltration of the right atrium, atrioventricular (AV) groove, lateral myopericardium, and lateral pericardium (Figure 2).
(a) Follow-up noncontrast CT after chemotherapy demonstrates marked treatment response with visualization of the pericardial fat (arrows) and mild residual soft tissue along the anterior RV and lateral LV (arrowheads). (b) CMR DME performed for further characterization shows avid delayed enhancement of the soft tissue along the lateral LV (arrowheads), compatible with posttreatment scar.
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fig3
A follow-up chest CT 5 months later demonstrated marked decrease in soft tissue cardiac and pericardial infiltrate, and repeat CMR showed focal scarring along the lateral left ventricular wall (Figure 3).