Apical hypertrophic cardiomyopathy

Case contributed by Jayanth Keshavamurthy
Diagnosis certain

Presentation

Abnormal CT chest and hence MRI of heart ordered for evaluating cardiac apex.

Patient Data

Age: 40 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Chest

ct
This study is a stack
Axial C+
arterial phase
This study is a stack
Axial
non-contrast
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Info

Fat density seen at apex of the heart.

Apex is thick, easier to appreciate in retrospect.

Cardiac

mri
4ch
T1
4ch T2
fat sat
3ch
SSFP
2ch
SSFP
2ch DIR late
phase (~10 mins)
3ch DIR late
phase (~10 mins)
4ch DIR late
phase (~10 mins)
sax DIR late
phase (~10 mins)
sax DIR late
phase (~10 mins)
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Info

Left ventricular function: hyperdynamic left ventricular systolic function
Valvular function: no systolic anterior motion of the mitral valve
Delayed enhancement: Tiny focus of late gadolinium enhancement at the distal apex of the septum towards the left ventricle

Case Discussion

Findings are suggestive of apical hypertrophic cardiomyopathy. There is no apical aneurysm.
Recommend a 12-lead electrocardiogram to evaluate for T-wave inversion. Look at the apex on the 3-chamber view in diastole, it is not thinned out as usual. It has a spade-like appearance.

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