PMC5576500_01
PMC5576500_02
(a, b): Four-chamber (a) and three-chamber (b) bright blood cardiac magnetic resonance imaging at age 22 showing asymmetric septal hypertrophy. (c): Short-axis post-contrast imaging at age 22 showing diffuse sub-epicardial left ventricular free wall late gadolinium enhancement (green arrows) and multiple focal septal areas of mid-myocardial late gadolinium enhancement (red arrows). (d): Short-axis post-contrast imaging at age 27 showing progression of sub-epicardial left ventricular free wall enhancement (green arrows) and progression in terms of both number and thickness of focal areas of mid-myocardial septal enhancement (red arrows).
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F1
His initial cardiac magnetic resonance at age 22 demonstrated severe asymmetric septal hypertrophy (Fig 1a and b), near-obliteration of the mid-left ventricle in systole, and systolic anterior motion of the mitral valve. On post-contrast imaging (Fig 1c), diffuse sub-epicardial late gadolinium enhancement in the left ventricular free wall (green arrows) and multiple focal septal areas of mid-myocardial late gadolinium enhancement (red arrows) were seen. His latest cardiac magnetic resonance study at age 27 (Fig 1d) demonstrates sub-epicardial partial thickness late gadolinium enhancement in large areas of the anterior, lateral, and inferior left ventricular free wall segments (green arrows) and mid-myocardial late gadolinium enhancement in the anterior and inferior ventricular septum starting at the level of the papillary muscles and extending to the apex (red arrows).