Navigating the Challenges of Diagnosing Arrhythmogenic Cardiomyopathy

This case report describes a 55-year-old asymptomatic woman with persistent T-wave inversion who was initially suspected of having arrhythmogenic cardiomyopathy (ACM) based on cardiac magnetic resonance findings of epicardial lipomatosis and a dyskinetic right ventricular segment. Advanced CMR with T1 mapping later reclassified the dyskinetic segment as a benign anatomical variant-a "butterfly apex"-and confirmed isolated epicardial fat without myocardial infiltration. Over long-term follow-up, no arrhythmias or structural progression occurred. The case highlights the critical role of multimodal imaging in differentiating ACM from benign anatomical mimics, thereby preventing misdiagnosis and unnecessary intervention.