Cardiovascular radiology in acute and chronic Chagas' myocardiopathy

Abstract The cases of 26 patients with Chagas' myocarditis have been analyzed with regard to the relationship between the x-ray changes, stage of the disease, and pathologic changes. Eight of these patients were seen during the acute stage of the disease, and 18 during the chronic stage. All of the patients with the acute form of the disease had Schizotrypanum cruzi in the peripheral blood. Two patients died. Nests of Leishmania within the myocardial fibers were found at autopsy. From a series of 53 autopsies of patients with chronic Chagas' myocarditis and a positive complement fixation reaction to Schizotrypanum cruzi , 18 cases were selected for study (all of these patients were under 30 years of age). They showed histologic changes of varying degree consistent with a diagnosis of chronic myocarditis. The morphologic and dynamic data of the cardiac contour were analyzed, and the electrocardiogram provided an accurate outline of the projection of each ventricle onto the chest wall. The pathologic findings were correlated with the radiologic and kymographic findings. In acute Chagas' myocarditis the increased size of the cardiac shadow and the decreased amplitude of the cardiac pulsations are related to the severity of the inflammatory process. The altered morphology and cardiac dynamics seem to be related to the cellular infiltrate and the inflammatory edema of the myocardium. In chronic Chagas' myocarditis there is a close relationship between the intensity of the myocardial fibrosis, cardiac enlargement, and the decreased motility of the heart. The increase in the length of the myocardial fibers and the myocardial fibrosis are seemingly responsible for these findings.