We present a case of a 20-year-old Malay man with underlying tuberculous (TB) lymphadenitis who presented with shortness of breath and found to have submitral left ventricular aneurysm (SLVA). SLVA is well recognised but rare. Incidence of SLVA in Malay has never been documented. This is the first reported case of SLVA in Malays with concomitant thoracic aorta mycotic aneurysm. TB has been reported to be associated with SLVA. Treatment is either surgical or conservative. Imaging is required for diagnosis and preoperative assessment. Multimodality imaging include echocardiography (ECHO), cardiac CTangiography and the robust multiparametric cardiac MR (CMR). ECHO is the first line imaging and useful for initial detection of the aneurysm. CMR including the late gadolinium enhancement allows excellent visualisation of the LV aneurysm, tissue characterisation, cardiac function and detection of associated pathology as shown in this case.
DescriptionConjoined twins are very rare with incidence of 1 per 250 000 live births.1 Fetal MRI is an important adjunct to ultrasound particularly in evaluation of complex fetal anomalies and organ positions.2 3 This case report illustrates our first experience in MRI fetal of conjoined twins with the current available sequences.An 18-year-old G 2 P 0+1 , with no known medical illness, was diagnosed with conjoined twin pregnancy from antenatal ultrasound at 28 weeks. MRI of pelvis was performed using a 1.5 T Phillips using torso array coil. Sequences employed were Coronal T2 FB (free breathing), Axial T2 FB, Sagittal T2 FB, BB_SSh_Rtrig SE, Axial BTFE and BB_SSh_RTrig SE. The effective time echoof 188 s, 10 mm slice thickness. Each slice was performed in 2s, and the full sequences in each imaging plane require 27 s, 256×256 matrix and 34 cm field of view.It showed conjoined twins with single and fused heart, and liver represented a thoraco-omphalopagus presentation (figure 1).The images from MRI allow counselling with the parents regarding poor prognosis of the non-operable fused heart and liver (figure 2). The patient underwent emergency caesarean section due to premature labour. Two baby girls were found to be joined at the thorax and abdomen (fused heart and liver) with single umbilical cord insertion. The patients succumbed to death due to heart failure at day 2 of life.In our experience, the most useful MRI sequence is T2 FB in all three planes. The advent of fast acquisition sequences in MRI technology allows better images by minimising movement and breathing artefacts.
Fetal MRI of thoraco-omphalopagus conjoined twins
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