Investig Magn Reson Imaging.  2016 Jun;20(2):114-119. 10.13104/imri.2016.20.2.114.

Diagnosis of Right Ventricular Vegetation on Late Gadolinium-Enhanced MR Imaging in a Pediatric Patient after Repair of a Ventricular Septal Defect

• Jeong J
• Kim HJ
• Kim SM
• Huh J
• Yang JH
• Choe YH

• KMID: 2327423
• DOI: http://doi.org/10.13104/imri.2016.20.2.114

Abstract

We report a case of vegetation in a 4-year-old female with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. The patient had a history of primary closure for ventricular septal defect and presented with mild febrile sensation. No remarkable clinical symptoms or laboratory findings were noted; however, transthoracic echocardiography demonstrated a 14 mm highly mobile homogeneous mass in the right ventricle. On LGE CMR imaging, the mass showed marginal rim enhancement, which suggested the diagnosis of vegetation rather than thrombus. The extracellular volume fraction (≥ 42%) of the lesion was higher than that of normal myocardium. Based on the patient's clinical history of congenital heart disease and pathologic confirmation of the lesion, a diagnosis of infective endocarditis with vegetation was made.

Keyword

Infective endocarditis; Vegetation; Late gadolinium enhancement; Cardiovascular magnetic resonance imaging; Right ventricle; Congenital heart disease

MeSH Terms

Child, Preschool
Diagnosis*
Echocardiography
Endocarditis
Female
Heart Defects, Congenital
Heart Septal Defects, Ventricular*
Heart Ventricles
Humans
Magnetic Resonance Imaging*
Myocardium
Sensation
Thrombosis

Figure

• 

  Fig. 1 A 4-year-old female with a vegetation in the right ventricle (RV). (a) Initial transthoracic echocardiography shows a14 × 11 mm-sized highly mobile homogeneous mass (arrowhead) in RV, which is attached to the ventricular septal defect primary closure site. (b-e) CMR (b), 8 days after initial the echocardiography. The mass (white arrows) is seen in the RV, attached to the anterior wall on a short-axis-view cine MR image and shows iso-signal intensity as compared with the myocardium on T2-weighted (c) and T1-weighted (d) images. Late gadolinium-enhanced image in a short-axis view (e) demonstrates marginal rim enhancements (black arrows). (f, g) A T2 map (f) and postcontrast-T1 map image (g) show that the T2 relaxation time of the lesion is similar to that of normal left ventricular myocardium and that peripheral components (arrows) of the vegetation show lower T1 values than the myocardium. (h) Resected specimen shows a soft, round, encapsulated, and whitish mass consisting of granular tissue.

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