This is a 53-years old man who had giant inverted T waves, on the ECG, during a routine health check-up. The echocardiogram was reported normal and a cardiac CT was performed.
The coronary arteries were normal (Fig. 1), but there was an abnormal look to the apical region of the LV on the volume rendered images. The short axis cine showed significant symmetric apical hypertrophy with systolic obliteration of the LV cavity.
A cardiac MRI was then performed (cine files), which confirmed these findings, showing symmetric apical hypertrophy. The delayed hyperenhanced images did not show any abnormal enhancement, suggesting absence of fibrosis, which may be considered an adverse prognostic factor.
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For apical hypertrophy, CMR is perhaps the gold standard. Echocardiography consistently misses mild degrees of hypertrophy because of technical reasons, mainly the apex being too close to the chest wall and transducer.
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