Clinical utility of cardiac magnetic resonance imaging in Churg–Strauss syndrome: case report and review of the literature

Abstract

We describe a case of an individual with Churg-Strauss syndrome who presented with a cerebrovascular accident (CVA) secondary to left ventricular intracavitary thrombi. Noninvasive cardiovascular imaging using transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) was used to identify the cardioembolic source of CVA. The clinical utility of CMR in the management of patients with Churg-Strauss syndrome is reviewed.

Churg–Strauss Syndrome Presenting with Acute Myocarditis and Cardiogenic Shock

“…Presence of ANCA is associated with an increased risk of glomerular disease and peripheral neuropathy, whereas absence of ANCA is associated with a higher frequency of heart involvement [6,11,12], consistent with the present observation. Cardiac MRI demonstrated late gadolinium enhancement in the subendocardium particularly in the apical and mid segments of the left ventricles [6,[11][12][13][14][15]. Compared to late enhancement lesions in non-ischaemic cardiomyopathy, ischaemic cardiomyopathy [16][17][18][19] or viral myocarditis [20] that are often found in the middle or epicardial layers of the myocardial wall, the pattern of CSS lesions predominantly involve subendocardial locations.…”

Cardiac Magnetic Resonance Imaging Showing Complete Resolution of Subendocardial Involvement in Churg-Strauss Syndrome

“…4 Echocardiography is necessary to diagnose cardiac involvement, and contrast-enhanced CMRI can show subendocardial involvement. 5,6 High-dose corticosteroids are the mainstay of treatment and can fully reverse myocardial involvement. 4 In this young patient with Churg-Strauss syndrome, contrast-enhanced CMRI showed diffuse subendocardial involvement at presentation and complete resolution and improvement of the left ventricular function after treatment with steroids.…”

Multiple cerebral infarctions in a patient with Churg-Strauss syndrome

“…Even though embolization of the left ventricle is described in one of the patients, mechanisms of the cerebral infarctions, as in most other series, remain elusive. Few details can be found when cardiac insufficiency or thrombus are involved [3]. Most authors attribute cerebral infarctions to CSS-associated vasculitic complications even though there is rarely a description given of the vessels involved and the imaging pattern.…”