Case #15

Clinical History:

A 62 year old man with a past medical history had an exercise myocardial perfusion scan for evaluation of chest pain.  Resting perfusion images were performed with thallium-201.  After the resting images he exercised for 5.5 minutes on the Bruce protocol stopping exercise for shortness of breath.  Prior to termination of exercise Tc-99m sestamibi was injected and stress images were performed 20 minutes later.
 
 
Raw data
Rest
Thallium-201
Exercise
Tc-99m sestamibi
Thallium-201 raw data Tc-99m sestamibi stress
 
 
SPECT reconstruction
Short
axis
Stress Tomographic slices
Rest
Horizontal
long axis
Stress
Rest
Vertical
long axis
Stress
Rest
 
 
Gated sestamibi
Apical
short axis
Basilar
short axis
Gated sestamibi images
Vertical
long axis
Horizontal
long axis

Evaluate the regional wall motion and regional wall thickening.  Why is there a disparity between wall motion and thickening?
 

Diagnosis

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J. Anthony Parker, MD PhD, Tony_Parker@bidmc.harvard.edu