[Translation from English to Japanese ] ECG revealed a sinus rhythm at 57 beats per minute, with T-wave inversions i...

Original Text / English

ECG revealed a sinus rhythm at 57
beats per minute, with T-wave inversions in the
inferolateral leads, and was otherwise normal.
The patient was admitted to the hospital.

On the first hospital day, a chest radiograph
was normal. Transthoracic echocardiography revealed
segmental apical left ventricular dysfunction
with an apical aneurysm, near obliteration of
the mid-left ventricular cavity at end systole, and
overall normal left ventricular systolic function
(estimated ejection fraction, 58%).

On the second day, cardiac telemetry showed
intermittent sinus bradycardia, with no ectopy. The
abdominal pain decreased. Constipation, with
bloating and abdominal cramping, and hypoactive
bowel sounds developed.

Original Text / English

Figure 1. Abdominal CT on Admission.
An oblique axial multiplanar reformatted image from
the abdominal CT scan, obtained after the administration
of contrast material (Panel A), shows multiple peripheral
wedgelike hypodensities involving the renal
cortexes bilaterally (arrows). The appearance is characteristic
of multifocal renal infarctions. The hypodensities
were new, as evidenced by comparison with CT
scans obtained 4.5 years earlier. An oblique coronal
multiplanar reformatted image of the heart from the
abdominal CT scan (Panel B) shows thinning of the
left ventricular apex, with aneurysmal dilatation (arrow).
This was unchanged from the CT scans obtained
4.5 years earlier.

Original Text / English

Dr. Eric M. Isselbacher: This patient had been relatively
well until the recent onset of abdominal pain,
with radiation to the right side and back. The
long differential diagnosis of abdominal pain was
narrowed down by the findings of the abdominal
and pelvic CT. May we review the imaging studies?


Takotsubo Cardiomyopathy
Left ventricular apical aneurysms are seen in takotsubo
cardiomyopathy, a condition also known
as transient left ventricular apical ballooning syndrome
or stress cardiomyopathy.


Although it is uncommon, small
left ventricular aneurysms can arise even in the
presence of preserved global left ventricular systolic
function, probably secondary to intense inflammation.

Translation / Japanese

エリックM.アイセルベーカー博士：この患者は、右側と背中にかける腹痛が最近発生するまでは、比較的良好でした。腹痛の長期鑑別診断は、腹部と骨盤のＣＴ結果によって特定されました。画像グループのレビューをしてもよいですか。

たこつぼ心筋症
左心室先端の動脈瘤がたこつぼ心筋症と判断でき、それは、左心室先端の無収縮を特徴とする症候群、またはストレス心筋障害を一時的に引き起こすとして知られている症状である。

稀な症状として、小さな左心室瘤は、保存された包括的な左心室収縮機能がある場合でも発生することがあり、二次的に激しい炎症を引き起こすであろう。