Advertisement

The Reply

      In regard to the letter by Movahed, we recognize that there were no comments on the so-called Movahed's sign in our Images in Radiology publication.
      • De Lorenzo A.
      • Lessa C.
      • Camargo G.
      • et al.
      A not so obvious cause of chest pain: pulmonary hypertension.
      However, we note that the American Society of Nuclear Cardiology 2010 Guidelines for Nuclear Cardiology procedures state that in myocardial perfusion single photon emission computed tomography reporting, “the size of the right ventricle should be noted, as right ventricle dilation can provide a clue to the presence of right heart volume overload,”
      • Holly T.A.
      • Abbott B.G.
      • Al-Mallah M.
      • et al.
      Single-photon emission computed tomography.
      but have not yet incorporated the description of Movahed's sign.
      • Movahed M.R.
      • Hepner A.
      • Lizotte P.
      • Milne N.
      Flattening of the interventricular septum (D-shaped left ventricle) in addition to high right ventricular tracer uptake and increased right ventricular volume found on gated SPECT studies strongly correlates with right ventricular overload.
      The scintigraphic finding of an enlarged right ventricle was described more than 3 decades ago. In 1976, Cohen et al
      • Cohen H.A.
      • Baird M.G.
      • Rouleau J.R.
      • et al.
      Thallium 201 myocardial imaging in patients with pulmonary hypertension.
      addressed myocardial perfusion imaging as “a useful technique for assessing the effects of chronic pulmonary hypertension on the right ventricular myocardium.” In 1979, Khaja et al
      • Khaja F.
      • Alam M.
      • Goldstein S.
      • Marks D.S.
      Diagnostic value of visualization of the right ventricle using thallium-201 myocardial imaging.
      reported the diagnostic significance of visualizing the right ventricle on thallium-201 myocardial perfusion scans. Since then, several studies have been published, and our aim was not to cover all the available literature on this topic, but only to present thought-provoking images that might be found in daily practice during the search for coronary artery disease but that would point at a different but important condition. Nonetheless, we believe that the D-shaped left ventricle is a useful observation that may help uncover pulmonary hypertension as a cause of chest pain.

      References

        • De Lorenzo A.
        • Lessa C.
        • Camargo G.
        • et al.
        A not so obvious cause of chest pain: pulmonary hypertension.
        Am J Med. 2014; 127: 605-607
        • Holly T.A.
        • Abbott B.G.
        • Al-Mallah M.
        • et al.
        Single-photon emission computed tomography.
        J Nucl Cardiol. 2010; 17: 941-973
        • Movahed M.R.
        • Hepner A.
        • Lizotte P.
        • Milne N.
        Flattening of the interventricular septum (D-shaped left ventricle) in addition to high right ventricular tracer uptake and increased right ventricular volume found on gated SPECT studies strongly correlates with right ventricular overload.
        J Nucl Cardiol. 2005; 12: 428-434
        • Cohen H.A.
        • Baird M.G.
        • Rouleau J.R.
        • et al.
        Thallium 201 myocardial imaging in patients with pulmonary hypertension.
        Circulation. 1976; 54: 790-795
        • Khaja F.
        • Alam M.
        • Goldstein S.
        • Marks D.S.
        Diagnostic value of visualization of the right ventricle using thallium-201 myocardial imaging.
        Circulation. 1979; 59: 182-188

      Linked Article