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Left Ventricular Crypts in Arrhythmogenic Cardiomyopathy: Incidental Finding or Underrecognized Phenotype?
Amal Abdellatif1, Omar Aljaziri1, Sarah Qureshi1
1Hamad Medical Corporation, Doha, Qatar.
Insights
Arrhythmogenic cardiomyopathy (ACM) can involve both ventricles. In high-risk individuals, left ventricular (LV) crypts detected via cardiac magnetic resonance imaging (CMR) may indicate ACM.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Arrhythmogenic cardiomyopathy (ACM) involves fibrofatty myocardial replacement, leading to arrhythmias and sudden cardiac death.
- ACM diagnosis typically relies on identifying characteristic myocardial changes.
Background:
Arrhythmogenic cardiomyopathy (ACM) is characterized by fibrofatty myocardial replacement predisposing patients to arrhythmias and sudden cardiac death.
Case Summary:
We describe a 51-year-old man with syncope, characteristic changes on electrocardiogram, and a family history of sudden cardiac death. Imaging showed right ACM features in addition to multiple left ventricular (LV) crypts. Cardiac magnetic resonance imaging (CMR) confirmed the right ACM features and further revealed LV fibrosis corresponding to the crypts. The patient was diagnosed with biventricular ACM and received an implantable cardioverter-defibrillator for primary prevention.
Discussion:
This case demonstrates that the detection of crypt-like LV wall invaginations in high-risk patients warrants CMR. LV wall fibrosis and thinning coinciding with the crypts confirm LV ACM.
Take-Home Messages:
ACM can present with biventricular involvement. In a high-risk patient with suspected ACM, LV crypts warrant CMR to help distinguish them from pathological LV wall fibrosis and thinning. LV crypts in high-risk patients warrant further future reporting.
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