title: Coexistence of apical hypertrophic cardiomyopathy and endomyocardial fibrosis with calcification: diagnosis using multimodality imaging.
abstract: A 48-year-old man from West Africa was evaluated for dyspnea. Echocardiography showed an echolucent mass at the left ventricular apex surrounded by a dense ridge of tissue, suggesting endomyocardial fibrosis (EMF). Doppler echocardiography showed restrictive hemodynamics and intramyocardial coronary blood flow at the hypertrophied apex, suggesting apical hypertrophic cardiomyopathy (ApHCM) with calcified thrombus. Cardiac magnetic resonance imaging showed a thickened myocardium with apical cavity obliteration and endomyocardial calcification, and gadolinium contrast demonstrated marked bright subendocardial and diffuse patchy intramyocardial hyperenhancement in the hypertrophied apical wall segment, confirming coexistence of EMF and ApHCM. Workup for known disorders of calcification was negative.
authors.affiliation: Aurora Cardiovascular Services.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Muthukumar
authors.affiliation: Aurora Cardiovascular Services.
authors.forename: M Fuad
authors.initials: MF
authors.lastname: Jan
authors.affiliation: Department of Radiology Aurora Sinai/Aurora St. Luke's Medical Centers Milwaukee Wisconsin USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Whitnah
authors.affiliation: Aurora Cardiovascular Services.
authors.forename: A Jamil
authors.initials: AJ
authors.lastname: Tajik
keywords: Delayed enhancement; Endomyocardial fibrosis; Hypertrophy; Magnetic resonance imaging