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(Circulation. 2008;117:1745-1749.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Magnetic Resonance Assessment and Therapy Monitoring of Cardiac Involvement in Churg-Strauss Syndrome

Hannibal Baccouche, MD; Ali Yilmaz, MD; Dominik Alscher, MD; Karin Klingel, MD; Jose Fernando Val-Bernal, MD, PhD; Heiko Mahrholdt, MD

From the Departments of Cardiology (H.B., A.Y., H.M.) and Nephrology (D.A.), Robert-Bosch-Medical Center, Stuttgart, Germany; Department of Molecular Pathology, University Hospital of Tuebingen, Germany (K.K.); and Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain (J.F.V.-B.).

Correspondence to Heiko Mahrholdt, MD, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany. E-mail heiko.mahrholdt@rbk.de

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

A 39-year–old man, with a temperature of 38.5°C and sinus tachycardia, was admitted for work-up of chest pain. He had a history of asthma, recurrent pneumonia, sinusitis, and nasal polyposis. Clinical examinations, ECG (Figure 1) and chest x-ray (Figure 2) on admission were suspicious for perimyocarditis. Routine blood analysis revealed an elevated erythrocyte sedimentation rate (88 mm/h; normal <15 mm/h) and a normal leukocyte count (7200/mm³) with 21% eosinophilic granulocytes (normal 1% to 6%). Levels of C-reactive protein and immunoglobulin E were elevated at 14.0 mg/dL (normal 0.1 to 0.5 mg/dL) and 237 U/mL (normal <100 U/mL), respectively. Thus, Churg-Strauss syndrome with perimyocardial involvement was suspected.

View larger version (66K):   Figure 1. Twelve-lead ECG obtained at initial presentation in our emergency room, demonstrating ST-abnormalities suspicious for perimyocarditis.

View larger version (161K):   Figure 2. Frontal posterior–anterior chest x-ray on admission. Note the enlarged pulmonary hila, as well as the relation of the cardiac silhouette to the lateral distance (16 cm/32.5 cm), suggesting mild cardiac enlargement, pericardial effusion, or a combination of these conditions.

Because echocardiography could not provide any information on myocardial involvement in this case (Figure 3; for full-motion images, see Movie I in the online-only Data Supplement), the patient was referred for cardiovascular magnetic resonance imaging (CMR; 1.5 Tesla Sonata, Siemens Medical Systems, Erlangen, Germany). Cine images were acquired using fast-gradient echo steady-state free precession sequences that demonstrated increased pericardial thickness (5 mm), as well as small amounts of pericardial effusion (Figure 4). Systolic left ventricular (LV) function . . . [Full Text of this Article]

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