Case of the week 0714:

1
Case of the week 07-14
Clinical. A 59 year old with an 8 year history
of asymptomatic ARVC diagnosed by family
screening. A disease causing mutation in
plakophilin was found. Type 1 diabetes since
childhood. Recent echo showed a possible new LV
apical aneurysm. Coronary angiography
normal. Cine CMR RV moderate impairment with
multiple wall motion abnormalities (micro
aneuysms). Discreet areas of LV thinning (apex,
mid antero-lateral wall) Tissue characterisation
intrinsic contrast Fatty infiltration of the
RV side of the septum, parts of the moderator
band and RV trabeculae, also the lateral wall of
the LV (T1W TSE, nulling with fat sat). Tissue
characterisation extrinsic contrast LGE
matching the fatty infiltration (possibly
explained by the shorter T1 of fat) but
additional RV free wall LGE and in the LV not
explained by the fat. Interpretation LV
involvement is probably more common than
initially recognised in ARVC. Scanner Siemens
avanto.
References Sen-Chowdhry S et al. Circulation
20071151710-20 Sen-chowdhry S et al. JACC
2006482132-40
Authors Antonis Pantazis, Perry Elliott The
Heart Hospital, London, UK