Case of the week 0614: Delayed enhancementtargeted biopsy

1
Case of the week 06-14 Delayed
enhancement-targeted biopsy
Clinical A 53-yr-old ? with 2 types of
symptomatic VT. One VT with LBBB and superior
axis suggested origin from RV inflow, likely from
IVS. Rest ECG shows inverted T waves inferiorly
and no epsilon wave. EPS normal coronaries 3 VT
morphologies, one resembling the clinical VT.
CMR No fatty infiltration on T1W. Normal RV
LV size function (bright mid-myocardial signal
on short axis SSFP cine is due to prior
Gadolinium injection). Late Gd-imaging (IR-FLASH)
shows mid-myocardial enhancement of the IVS
(close to the inflow -arrowheads), anterior RV
(arrow) and lateral LV walls. Biopsy Targeted
to the enhancing areas fibro-fatty ARVD type
histology. Perspective Delayed enhancement on
CMR may correspond to the arrhythmogenic foci. It
may help target a biopsy. CMR system 1.5 T
Magnetom Avanto, Siemens, Germany.
Gurpreet Singh Gulati, Rajnish Juneja, Rakesh
Yadav Ruma Ray, Cardiothoracic Center, All India
Institute of Medical Sciences, Ansari Nagar, New
Delhi-110029, India