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Extensive myocardial calcification in septic shock and precursor B-cell acute lymphoblastic leukaemia 1 2 2 1 2 Rena Ng , David Ferreira *, Allan Davies , Elizabeth Hesketh , and Bruce Bastian 1 2 Paediatric Department, John Hunter Children’s Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia; and Cardiovascular Department, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia * Corresponding author. Tel: (61)433870118; Fax: (61)249214210. E-mail: firstname.lastname@example.org A 15-year-old male with Klinefelter syndrome presented with neutropenic septic shock and multiorgan failure. Bone marrow biopsy dem- onstrated precursor B-cell acute lymphoblastic leukaemia. AEIOP chemotherapy was initiated on Day 6 of admission (prednisone, vincristine, daunorubicin, pegylated asparaginase, metho- trexate, and intrathecal cytarabine). At Day 21, during his induction phase, echocardiography demonstrated new widespread myocardial cal- cification. On apical four chamber views, there was dense calcification of the left and right ven- tricular myocardium, the mitral annulus, the interventricular septum, and the interatrial sep- tum (Panel A). Involvement of the papillary muscle was seen on the parasternal short axis view (Panel B). The echocardiographic ejection fraction was visually estimated at 50% (see Supplementary data online, Video S1). Computed tomography revealed dense myo- cardial calcification concentrated around the left ventricle (Panel C). The post contrast car- diac magnetic resonance images demonstrated multifocal areas of delayed enhancement extending from the pericardium to the subendo- cardium with a small pericardial effusion (Panel D). The left ventricular ejection fraction was measured as 36% with minimal tricuspid and mitral regurgitation (see Supplementary data online, Video S2). Extensive myocardial calcification is a rare radiological finding often associated with infection, inflammation, or cytotoxic medications. In this report, we present the rapid development of dystrophic myocardial calcification in the setting of septic shock and precursor B-cell acute lymphoblastic leukaemia. Supplementary data are available at European Heart Journal—Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author 2017. For permissions, please email: email@example.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/3/309/4725020 by Ed 'DeepDyve' Gillespie user on 22 March 2018
European Heart Journal – Cardiovascular Imaging – Oxford University Press
Published: Mar 1, 2018
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