Hypertrophic cardiomyopathy complicated by left ventricular apical necrosis and aneurysm in a young man: FDG-PET findings

Abstract

A 29-year old male was transferred to our hospital with an abnormal chest X-ray finding diagnosed as hypertrophic cardiomyopathy with apical necrosis and aneurysm formation. Four years after the initial hospitalization, we confirmed the aneurysm and necrosis using both integrated positron emission tomography (PET) and computed tomography (CT) scanning. The F-18 2-fluoro-2-deoxy-D-glucose (FDG) PET/CT enabled precise localization of the aneurysm, which was found to be composed of semi-lunar calcification of non-metabolic myocardium. A contrast-enhanced CT angiography showed an hour-glass appearance of the left ventricular cavity. The integrated PET/CT fusion scanner is a novel multimodality technology that allows for a comprehensive analysis of the anatomical and functional status of complex heart disease. Based on these findings, long standing mechanical and physiologic abnormalities may have led to chronic ischemia in the hypertrophied myocardium, induced necrosis and calcification at the cardiac apex.

Figure 1

Fluoroscopic image showing circular calcification at the left lower chest (arrowheads).

Figure 2

A left ventriculogram revealed a bottle gourd-shaped left ventricular contour with a passive filling at the apical aneurysm which connected with narrow long neck (arrows).

Figure 3

Two serial sections of sagittal cardiac F-18 PET/CT fusion images. A focal hypertrophic myocardial mass (arrow) is seen at the left apical ventricle (A). On a more lateral section, a crescent-shaped calcification (arrow) with hypometabolism was seen (B).

Figure 4

Three-dimensional reconstruction of multi-slice spiral CT angiography showing the shape of the heart. The apical aneurysm with calcification was connected to the apex of left ventricle with a long neck (A and B). The left anterior coronary artery was located more medially than usual at the left ventricular apex.