LGE at HINGE POINT (white arrows) in SEPTUM (red arrows) and INFEROSEPTAL (yellow arrows) ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY 37-year-old female with a history of hypertrophic cardiomyopathy presented to the ER with pleuritic chest pain CXR showed cardiomegaly with evidence of left ventricular enlargement and left atrial enlargement. CTA showed no evidence of PE but confirmed the presence of LAE and LVH with asymmetric septal thickening and relative sparing of the apex. A pyrophosphate scan was negative for amyloidosis An echocardiogram confirmed the presence of an obstructive cardiomyopathy with systolic anterior motion of the mitral valve and late systolic mitral regurgitation. The left atrium was enlarged and the right atrium was mildly enlarged. The ejection fraction was normal and estimated to be between 64%. There was a resting gradient across the outflow tract of 40-68 mmHg. LV mass index was 156g/sq m MRI confirmed the findings of the echo showing asymmetric septal hypertrophy, systolic anterior motion of the mitral valve with mitral regurgitation. The LA was 5.2cms, septal wall in diastole was 27.6mms and free wall was 16.8 mms. LV cavity size in diastole was normal. RA and RV were normal. EF was 70% and LV mass was 130g/ sq. m Nodular LGE was noted in the mid myocardium in the inferoseptal region at the hinge points and at the antero-apical regions Ashley Davidoff MD LGE ANTERIOR APICAL (arrow) ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Ashley Davidoff MD
LGE ANTERIOR APICAL (arrow) ASYMMETRIC HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY Ashley Davidoff MD LUPUS MYOCARDITIS Delayed enhancement images, 4-chamber views. B2 demonstrates interventricular patchy enhancement (arrow) on cardiac MRI performed during an SLE flare and active chest pain. Appearance is typical for myocarditis and a new finding compared to the baseline scan A, with some residual involvement after resolution of the SLE flare and medical treatment (C2). The finding of myocarditis is supported by a patchy enhancement (arrow), consistent with myocardial edema and active inflammation on T2-weighted images without fat saturation. No active inflammation is noted on a followup scan (C1). Goykman et al Subendocardial Ischemia and Myocarditis in Systemic Lupus Erythematosus Detected by Cardiac Magnetic Resonance Imaging The Journal of Rheumatology February 2012, 39 (2) 448-450; DOI: https://doi.org/10.3899/jrheum.110812
LINEAR NODULAR LGE in SARCOIDOSIS CMR images demonstrating 3-dimensional LGE imaging (top row), also fused with FDG-PET signal (bottom row), suggestive of active inflammation surrounding regions of scar (arrows) in a patient with unexplained cardiomyopathy and suspected cardiac sarcoidosis. Images are shown in the 4-chamber, short-axis, and 2-chamber orientations, respectively. Reproduced with permission from White et al. Courtesy https://www.acc.org/latest-in-cardiology/articles/2017/04/10/08/43/cardiac-mri-vs-pet