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(Circulation. 2003;107:2519.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Myocardial Fibrosis in Fabry Disease Demonstrated by Multislice Computed Tomography

Comparison With Biopsy Findings

Nobusada Funabashi, MD; Tetsuya Toyozaki, MD; Yasunori Matsumoto, MD; Masayori Yonezawa, MD; Noriyuki Yanagawa, RT; Katsuya Yoshida, MD; Issei Komuro, MD

From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine (N.F., T.T., Y.M., M.Y., K.Y., I.K.); and the Department of Radiology, Chiba University Hospital (N.Y.), Chiba, Japan.

Correspondence to Issei Komuro, MD, Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. E-mail komuro-tky@umin.ac.jp

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A54-year-old man presented with dyspnea on effort. Echocardiogram revealed reduced apical wall motion of the left ventricle (LV) with extreme hypertrophy of the interventricular septum (IVS). Conventional coronary angiogram showed normal coronary arteries. Endomyocardial-biopsy specimens obtained from the IVS revealed extensive vacuolization of cardiac myocytes and mild fibrosis on light microscopy, and typical lysosomal inclusions with a concentric lamellar configuration were seen with electron micros-copy (Figure 1). With these findings and low plasma -galactosidase activity, he was diagnosed as having Fabry disease. To evaluate the characteristics of the LV, ECG-gated enhanced multislice computed tomography (CT) (Light Speed Ultra, General Electric) was performed with a 1.25-mm slice thickness, helical pitch 3.25. After intravenous injection of 100 mL of iodinated contrast material (350 mgI/mL), CT scanning was performed with retrospective ECG-gated reconstruction at 30 seconds and 8 minutes after injection. In the axial source images, extreme hypertrophy of the IVS and the posterior wall of the LV compared with the apical and lateral walls of the LV could be observed (Figure 2). The apical and lateral portions of the LV revealed lower CT intensity than the IVS in the early phase (arrows), and in the late phase they were abnormally enhanced compared with the IVS, suggesting fibrotic changes in the apical and lateral myocardium. Therefore, we concluded that despite the IVS biopsy results, more fibrotic changes occurred in the apical and lateral portions of the LV rather than in the IVS.

View larger version (58K): [in this window] [in a new window]   Figure 1. Histological findings of endomyocardial-biopsy specimens. . . . [Full Text of this Article]

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