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Case Reports
. 2014 Feb 6;370(6):559-66.
doi: 10.1056/NEJMcps1213196.

Clinical problem-solving. Missing elements of the history

Larry A Allen, Amrut V Ambardekar, Kalpana M Devaraj, Joseph J Maleszewski, Eugene E Wolfel
Case Reports

Clinical problem-solving. Missing elements of the history

Larry A Allen et al. N Engl J Med. .
No abstract available

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Conflict of interest statement

Dr. Allen reports receiving consulting fees from Johnson & Johnson, Novartis, Janssen, and Amgen; Dr. Wolfel, lecture fees from Medical Educational Resources; and Dr. Ambardekar, consulting fees from Cytokinetics. No other potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. Transthoracic Echocardiogram Obtained 3 Months before Placement of a Left Ventricular Assist Device
The parasternal long-axis view shows reduced left ventricular systolic function in the absence of left ventricular dilatation or hypertrophy.
Figure 2
Figure 2. Micrographs of Specimens of Apical Left Ventricular Tissue
Panel A shows a photomicrograph of a specimen of normal myocardium (hematoxylin and eosin) obtained from an autopsy specimen. Panel B shows a photomicrograph of a specimen of the patient’s left ventricular apical core (hematoxylin and eosin) obtained during implantation of a left ventricular assist device for cardiogenic shock. Moderate interstitial, pericellular fibrosis (arrows) and myocyte hypertrophy (arrowheads) are evident. Panel C shows a transmission electron micrograph of an autopsy specimen. Normal myocytes with abundant myofibrils (arrowhead) and morphologically normal mitochondria (asterisk) are present. Panel D shows a transmission electron micrograph of the patient’s left ventricular tissue. Myocytes have degenerative features, characterized by substantial loss of contractile units, intracytoplasmic lipid accumulation (arrows), and lipofuscin deposition (arrowheads). Panel E shows another transmission electron micrograph of the patient’s left ventricular tissue. Both a highly atypical, enlarged mitochondrion (arrowhead) and immediately beneath it several smaller mitochondria (arrows) containing abnormally configured cristae suggest direct mitochondrial injury.
Figure 3
Figure 3. Magnetic Resonance Image of the Pelvis 7 Months after Heart Transplantation
A coronal sagittal short-tau inversion recovery image with arrows pointing to the left pseudotumor is shown. There was a symmetric decrease in muscle mass. A lobular, mildly septated fluid collection posterior to the left greater trochanter, measuring 6.6 cm by 4.2 cm by 1.9 cm, with a thin-walled, well-defined, low-signal rim and no extension into the muscles was suggestive of a metallosis pseudotumor.
See this image and copyright information in PMC

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