Collapse In An Olympic Athlete

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Collapse In An Olympic Athlete - Page #3

Lab Studies: CMP, CBC, BNP, Mag, Phos, PT/PTT/INR, Influenza A, Throat Culture, Respiratory Pathogen PCR panel all negative Other Studies: CXR: Heart, mediastinum and hila: Stable enlarged cardiac silhouette. US Abd: Normal CT Head/Neck/Chest/Abd/Pelvis: Normal ECG: Sinus Bradycardia, right ventricular hypertrophy, ST Elevation EEG: Normal Cardiac Catheterization: Normal Coronaries Cardiac MRI: Severely dilated left ventricle with borderline ejection fraction. Large area of late gadolinium enhancement epicardially along the lateral wall involving approximately 50% wall thickness. Mild hypokinesis in the same area, with focal wall thinning. Late gadolinium enhancement of the pericardium was also noted involving particularly the left ventricle inferolaterally and the right ventricle anteriorly. On T2-weighted images, increased signal was observed in the myocardium laterally, consistent with the presence of edema. Case Photo #1 Case Photo #3 Cardiac PET Scan: Active inflammation in the basal lateral, anterolateral and inferior walls was consistent with Sarcoid. Case Photo #2 Echocardiogram: Ejection Fraction 35%. Left Ventricle/Left Atrium/Right Atrium size severely increased. Right Ventricle mildly increased. Right Ventricle/Left Ventricle systolic function moderately reduced. Mild aortic valve leaflet thickening. Mild tricuspid/mitral regurgitation was present. Cardiac Biopsy: Heart, right ventricle, endomyocardial biopsy: mild myocyte disarray and small degree of interstitial fibrosis (Masson trichrome stain). Endomyocardial biopsy: Immunohistochemical stains for CD163 and CD3 showed few diffusely scattered interstitial macrophages and even fewer interstitial T-lymphocytes Case Photo #8 Genetic Testing: Entire genome isolated from whole blood: negative for pathology Consultations: Cardiology Neurology Geneticist Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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