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JAMA Surgery Clinical Challenge |

Inside or Outside of the Heart? QUIZ ONLINE FIRST

Dai-Yin Lu, MD1; Jen Wei, MD, MSD2; Ming-Chon Hsiung, MD3
[+] Author Affiliations
1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2Division of Cardiovascular Surgery, Cheng-Hsin General Hospital, Taipei, Taiwan
3Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
JAMA Surg. Published online August 24, 2016. doi:10.1001/jamasurg.2016.2049
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A 61-year-old man with progressive shortness of breath for 1 week and myocardial infarction 1 month earlier had progressive dyspnea at rest, tachycardia, and tachypnea. Transthoracic echocardiography showed a hypoechoic mass and CT showed a large crescentic hypodense lesion. What is your diagnosis?

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Figure 1.

A, Transthoracic echocardiography, apical 4-chamber view, showing a hypoechoic mass (arrowhead). LA indicates left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. B, Computed tomography of the chest, axial view, showing a hypodense lesion surrounding the anterolateral wall of the left ventricle and apex (arrowhead).

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Figure 2.

The anterolateral wall of the left ventricle myocardium was replaced by a thick transmural hematoma with extensive necrosis (arrowheads).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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