This is a patient with right ventricular tachycardia, strongly suspected to have arrhythmogenic right ventricular dysplasia (ARVD). The cines (see below) show right ventricular dyskinesia involving the anterior and inferior walls and sacculations. Fat is seen in the septum and anterior wall (Figs. 1, 2), along with abnormal enhancement in the delayed hyperenhanced images (Figs. 3, 4).
The diagnosis of ARVD is suggested on MRI when there are areas of dyskinesia, sacculation and aneurysm formation along with fat infiltration of the RV wall. It has been recently postulated , as discussed in the accompanying "literature" blog that the accompanying fibrosis should enhance on the delayed hyperenhanced images. Since we have started implementing delayed hyperenhancement in our ARVD protocol, we have seen abnormal enhancement in two patients, including this one, though both of them also had obvious fat infiltration as well.
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