key: cord-0984955-ux8jla69
authors: Mochizuki, Junji; Nakaura, Takeshi; Hashimoto, Katsushi; Hata, Yoshiki
title: Detection of ventricular thrombi via electron density imaging in non-contrast spectral computed tomography performed to exclude pneumonia: a case report
date: 2022-04-05
journal: Eur Heart J Case Rep
DOI: 10.1093/ehjcr/ytac148
sha: 6192b161c66bb50bbf99cb7a4404da8bd2574aa7
doc_id: 984955
cord_uid: ux8jla69

nan

A 44-year-old man presented with emergent dyspnoea and lower extremity oedema. He had no other medical history and no risk factors for heart disease. The referring physician suspected bronchial asthma because of persistent cough, and salmeterol xinafoate and fluticasone propionate had been ineffective. Radiography showed pleural effusion, cardiomegaly, and pulmonary congestion, but pneumonia could not be excluded. Blood tests showed high levels of D-dimer (6.25 µg/mL) and N-terminal pro-B-type natriuretic peptide (5830 pg/mL), suggesting heart failure and aortic dissection, 1 the C-reactive protein level was normal (0.32 mg/L). Because the patient exhibited persistent cough, chest computed tomography (CT) with spectral CT was performed to exclude pneumonia prior to echocardiography. This case occurred during the coronavirus disease 2019 epidemic; the D-dimer level was high, and thrombosis was possible. 2 CT was prioritized because the cough and breathlessness symptoms hindered a long examination. Cardiac magnetic resonance imaging (MRI) was omitted because the patient struggled to maintain a supine position. Although non-contrast CT showed right lung pleural effusion, the findings enabled exclusion of pneumonia. Electron density imaging (EDI) is a spectral imaging method that measures electron density, 3 whereas conventional CT does not. Conventional CT showed no hyperintense regions ( Figure 1A and B) , and EDI revealed incidental findings of hyperintense regions in both ventricles ( Figure 1C and D; Supplementary material online, Videos 1 and 2) . Transthoracic echocardiography revealed severe diffuse biventricular hypokinesis ( Figure 1E and F). These areas corresponded to thrombi on EDI, confirming the diagnosis of heart failure. To our knowledge, ventricular thrombi have not been identified on non-contrast spectral CT EDI. Non-contrast CT EDI may facilitate diagnosis when MRI and echocardiography are difficult to perform.

Junji Mochizuki is a radiologic technologist at Minamino Cardiovascular Hospital. He got his master's degree from the International University of Health and Welfare. He has an interest in advanced cardiac CT imaging using spectral CT.

Supplementary material is available at European Heart Journal-Case Reports online.

D-dimer and BNP levels in acute aortic dissection

Thrombosis and coagulopathy in COVID-19

Accuracy of electron density, effective atomic number, and iodine concentration determination with a dual-layer dual-energy computed tomography system

A 27.3 mm × 20.7 mm × 15.4 mm hyperintense region (▵) is visible in the left ventricle; a 12.8 mm × 8.0 mm × 7.0 mm hyperintense region (▴) is visible in the right ventricle. The electron density values were 104.8% relative to the electron density of water (EDW) in the left ventricular cavity, 105.9% EDW in the left ventricular hyperintense region, 104.8% EDW in the right ventricular cavity, and 105.4% EDW in the right ventricular hyperintense region. The computed tomography numbers of the conventional images were 44.5 Hounsfield units (HU) in the left ventricular cavity, 58.0 HU in the left ventricular hyperintense region, 46.6 HU in the right ventricular cavity, and 52.3 HU in the right ventricular hyperintense region; these computed tomography numbers did not obviously differ among regions

We thank Angela Morben, DVM, ELS, and Ryan Chastain-Gross, PhD, from Edanz, for editing a draft of this manuscript.