case_images: PMC2257924_01
case_images: The dark color shows the intraventricular septum thickening (26 mm) and loss of perfusion in the medial septal segment (white arrowhead) demonstrated with low mechanical index contrast echocardiography.
case_images: 1476-7120-6-4-1.jpg
case_images: PMC2257924_01_1476-7120-6-4-1.jpg
case_images: F1
case_images: Sonovue as bolus of 0,1 ml) demonstrated an increase of septum thickness from 13 mm to 26 mm. Septal strain (6%) as well as strain rate (0,45/s) showed an non perfused areal of 2,3 x 3,3 cm in the middle of interventricular septum. (Figure 1 and 2).
case_images: Normal strain of basal intraventricular septum with 25% (yellow curve) and pathologic strain of middle intraventricular septum with 6% (green curve).
case_images: 1476-7120-6-4-2.jpg
case_images: PMC2257924_01_1476-7120-6-4-2.jpg
case_images: F2
case_images: Sonovue as bolus of 0,1 ml) demonstrated an increase of septum thickness from 13 mm to 26 mm. Septal strain (6%) as well as strain rate (0,45/s) showed an non perfused areal of 2,3 x 3,3 cm in the middle of interventricular septum. (Figure 1 and 2).
case_images: Arrow indicates the contrast medium in the interventricular septum.
case_images: 1476-7120-6-4-3.jpg
case_images: PMC2257924_01_1476-7120-6-4-3.jpg
case_images: F3
case_images: Tip of pigtail catheter was dislocated in between the trabeculae of the interventricular septum (Figure 3).
case_images: T1 weighted image in the short cardiac axis. Bright signal within the myocardium of the intraventricular septum shows intramyocardial hematoma (white arrow).
case_images: 1476-7120-6-4-4.jpg
case_images: PMC2257924_01_1476-7120-6-4-4.jpg
case_images: F4
case_images: T1 weighted image, after application of 0,2 mmol/kg body weight Gadolinium-DTPA with a preparation pulse to "null" normal myocardium. A bright signal, surrounding the hematoma, indicating myocardial fibrosis can easily be depicted (late gadolinium enhancement, arrowhead).
case_images: 1476-7120-6-4-5.jpg
case_images: PMC2257924_01_1476-7120-6-4-5.jpg
case_images: F5
case_images: MR-follow-up examination 8 weeks after contrast agent injection (same technique as described under Figure E): Transmural late gadolinium enhancement anteroseptal, transmural myocardial fibrosis (white arrow), no hematoma.
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case_images: PMC2257924_01_1476-7120-6-4-6.jpg
case_images: F6
case_images: At that point a MR-follow-up was performed (Figure 6).
case_images: Enddiastolic 4 chamber view of left ventricle.
case_images: 1476-7120-6-4-7.jpg
case_images: PMC2257924_01_1476-7120-6-4-7.jpg
case_images: F7
case_images: Endsystolic 4 chamber view of left ventricle: midseptal akinesia and wall thinning (white arrowhead).
case_images: 1476-7120-6-4-8.jpg
case_images: PMC2257924_01_1476-7120-6-4-8.jpg
case_images: F8