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Goldfarb et al  “We also found that fat deposition was predominately mid myocardial or mid epicardial, whereas results of prior autopsy and CT studies suggest that fat deposition almost always affects the subendocardium (28). MR imaging is unique for the study of fat deposition owing to its sensitivity to the off-resonance properties of fat, allowing fat-water separation imaging and the viewing of MI in all stages by using LGE imaging. ”

 

  • POST MI FAT

    Lipomatous Metaplasia

    •  Post  MI,
      • myofibroblasts produce collagen as a repair mechanism
      • Sometimes myofibroblasts
      • differentiate into adipocytes,
      • which is laid down in the scar
    • Consequence of myocardial infarction.
      • At autopsy
      • Lipomatous Metaplasia
      • was seen in about 70% of scars associated with
      • chronic ischemic heart disease
    • Lipomatous Metaplasia is also
    • a significant predictor
      • heart failure,
      • all-cause mortality,
      • sustained ventricular arrhythmia
ISCHEMIC CARDIOMYOPATHY
41 year old male presents with chest pain.
Axial CT with contrast at the level of the enlarged left atrium (LA) (a) reveals a dilated LV, with subendocardial fatty infiltration of the LV myocardium in the septum (white arrowhead), and apex red arrowhead). There is thinning of the myocardium in the septum and apex.
Image B is more inferior and taken at the level of the dilated RA and normal sized RV showing similar subendocardial fatty infiltration of the LV myocardium in the septum (white arrowhead), and apex red arrowhead). There is thinning of the myocardium in the septum and apex. The transverse dimension of the LV was 7.2 cms which is significantly dilated
These findings are consistent with myocardial infarction with and ischemic cardiomyopathy.
Ashley Davidoff MD
86943c03L  has LCA aneurysm
FAT IN LATERAL WALL – OBTUSE MARGINAL TERRIRTORY 81 year old Female
HEAVY CALCIFICATION OF THE CIRCUMFLEX ARTERY 81 year old Female
FAT AND CALCIUM IN THE HEART
56 year old male with history of coronary artery disease. Axial CT through the heart shows apical curvilinear fat (yellow arrowheads, ( a and b) associated with apical myocardial dystrophic calcification (green arrowheads c and d) both indicating prior apical MI. In addition there mitral annular calcification (red arrowhead, b) and multifocal fatty deposits in the RV (white arrowheads, a and b) usually depicting age related degenerative changes,
Ashley Davidoff MD

 

LV aneurysm with fat
The CommonVein.net
LV aneurysm with fat and dystrophic calcification
The CommonVein.net
LV aneurysm with fat and dystrophic calcification
The CommonVein.net
56 year old male with an apical aneurysm and dystrophic calcification in the aneurysm. Note also the fat within the septum
Ashley Davidoff
THECOMMONVEIN.net
70 year old male with apical aneurysm and associated subendocardial fat in the apex
Note also a dissection in the descending aorta
Ashley Davidoff
THECOMMONVEIN.net
This series of CT image shows a faint curvilinear lucency in the apical myocardium (a,b) as well as myocardial calcification. The lucency identified by red lines in b, is thought to be a fatty deposition in infarcted myocardial tissue, and the calcification represents dystrophic calcification in the necrotic tissue. Note that the calcification is not in the pericardium which is identified by the red markers in c. The pericardium is surrounded by pericardial at on the outside and epicardial fat on the inside. Included in the differential diagnosis is an apical aneurysm with calcification in clot. The calcification in the annulus is premature and unusual for this 56 year old male patient. Note the small bilateral pleural effusions. Courtesy Ashley Davidoff MD. 29601c01 code CVS cardiac heart MAC apical fat MI calcium myocardium apex cardiac imaging radiology CTscan radiologists and detectives
This series of non contrast CT scans through the inferior aspect of the LV shows a thin lucency of fat density which is located on the endocardial side of the myocardium. This suggests that there is significant associated thinning of the myocardium. There are a few punctate dystrophic calcifications in the septal component of the lucency. (a,b) The lucent abnormality also extends to the apex and the free wall of the LV. In images c and d the apex bulges forming an apical aneurysm. The findings are consistent with previous infarction with fatty changes in the infarcted region. Courtesy Ashley Davidoff MD. 38325c code cardiac heart LV apex septum free wall lucent fat calcification MI aneurysm CAD IHD imaging radiology CTscan
Ischemic Cardiomyopathy
Dilated LV
The CTscan is from a 76 year old man in whom the dominant finding is of left ventricular enlargement. The RA and RV are also enlarged based on this image, and LA was enlarged as well suggesting global cardiomegaly consistent with a cardiomyopathy. The clue to the cause of the enlargement is the segmental nature of the disease characterized by the asymmetry of the free wall and septum and the presence of fat (yellow overlay) in the thinned and probably scarred myocardium making ischemic cardiomyopathy the diagnosis. At the apex, there is there is a subtle calcification as well.
Courtesy Ashley Davidoff Copyright 2009 All rights reserved 86984c05.8s01
Characterization of the Left Ventricle using CT and MRI
The collage reveals the variation in the tissue characterization of the LV in disease
Top row (from l to r) Patient with anemia showing low density of the blood and soft tissue density of the thickened myocardium. The 2nd image shows a calcified apical aneurysm. The 3rd image is a calcified aneurysm of the apex with thrombus in the lumen. The 4th image shows fat in the septum and the apex reflecting a previous MI in this region
2nd row 1st image is an MRI showing subendocardial delayed gadolinium enhancement (LGE) in a patient with a prior infarct of the inferolateral portion of the LV. The middle image shows a dilated LV with mid myocardial LGE in a patient with congestive cardiomyopathy. The last image shows multicentric linear and nodular LGE prominent in the subepicardial region and consistent with sarcoidosis.
heart 0086
Ashley Davidoff MD

 

Links and References

Goldfarb et al   Myocardial Fat Deposition after Left Ventricular Myocardial Infarction: Assessment by Using MR Water-Fat Separation Imaging RadiologyVol. 253, No. 1