IMAGES IN CARDIOLOGY
Cardiac Amyloid
Marc L. Baker, MD, PhD and
Michael W. Fong, MD
University of Rochester, Rochester, New York
Manuscript received September 3, 2008;
accepted September 10, 2008.
A 74-year-old man with hypertension, hyperlipidemia, and tobacco abuse was admitted with progressively worsening dyspnea on exertion and weight gain. He had been diagnosed with a nonischemic cardiomyopathy, and his last known ejection fraction was 45%. A new echocardiogram showed concentric hypertrophy of the left ventricle (LV), a speckled appearance (A, white arrow), and an ejection fraction of 15% (left atrium [LA]). A cardiac magnetic resonance image was performed to rule out an infiltrative process, and delayed contrast enhancement imaging showed diffuse gadolinium uptake throughout the myocardium of both ventricles, as seen in the 4-chamber image (B, white arrows). A right ventricular biopsy was performed, and anatomic pathology showed extensive interstitial deposition of homogeneous hyaline material that showed metachromasia with crystal violet stain (C, black arrows) and Congo red positivity with apple-green birefringence (D, white arrows), confirming the diagnosis of cardiac amyloidosis.
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