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An atypical presentation of endomyocardial fibrosis diagnosed by cardiac MRI.

Cardiovascular MRI (CMR) is complementary to transthoracic echocardiography in the characterization of cardiac masses by offering a more complete view through its unlimited imaging planes and tissue characterization with the use of multiple imaging sequences. In this instance, CMR was able to noninvasively diagnose an atypical presentation of endomyocardial fibrosis (EMF) in a 44-year-old woman who presented with new-onset heart failure and a cardiac mass. Transthoracic echocardiography showed a 9-cm2 mass arising from the inferoposterior wall of the left ventricle (Figure 1, Supplementary Videos 1 and 2) resulting in a left ventricular outflow tract obstruction with a dynamic 30-mm Hg gradient. The posterior leaflet was tented, producing severe mitral regurgitation (Figure 1, Supplementary Videos 3 and 4). Left ventricular contractility appeared normal. Cardiac catheterization revealed moderate pulmonary hypertension with an elevated pulmonary capillary wedge. 



Figure 1. Transthoracic echocardiogram of intracardiac mass. A 9-cm2 mass (asterisk) from the inferoposterior wall of the left ventricle encompassing the posterolateral papillary muscle in the parasternal long (A) and apical 4-chamber (B) views. The mass led to severe mitral …