Number 08-21: Myocardial scarring from 2 distinct pathologies
Share |

Number 08-21: Myocardial scarring from 2 distinct pathologies

Case from: Theodoros D. Karamitsos, Cameron J. Holloway and Stefan Neubauer. University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK

History: Asymptomatic 62 yr ?. Diagnosed with HCM more than 20 with an abnormal ECG. Recent echo demonstrated concentric LVH. CMR to further assess this.

CMR: Asymmetric hypertrophy of the basal septum. Elevated left ventricular mass. Akinetic and thinned LV apex and hypokinetic mid anterior and anteroseptal walls. Late gadolinium enhancement revealed focal mid LV wall late enhancement at the RV insertion point. There was also transmural late gadolinium enhancement of the apex and subendocardial late gadolinium enhancement of the mid anterior wall.




Interpretation:  Two distinct pathologies appear to coexist; the significant asymmetric septal hypertrophy, increased left ventricular mass and patchy mid-wall fibrosis on late gadolinium enhancement are all typical features of hypertrophic cardiomyopathy. The anterior and apical wall motion abnormalities and late enhancement are likely to be due to previous myocardial infarction.

CMR perspective:
CMR confirmed the diagnosis of HCM but also revealed likely silent myocardial infarct.*

Mailing Address
19 Mantua Rd
Mt. Royal, NJ 08061
Contact Us
Connect With Us