This is a young man who came with palpitations. An echocardiogram showed an abnormal LV and the thought was of arrhythmogenic right ventricular cardiomyopathy (ARVC) or inflammatory cardiomyopathy. A cardiac MRI was performed.
The cine images show the unusual morphology. The papillary muscles insert directly onto the “apex”. The RV wraps around the LV. There is fat infiltration of the “apex” – essentially the epicardial fat seems to invaginate into the LV. In our case, the CT scan images also show calcification of the papillary muscles.