PMC8670900_01
(a) Four-chamber heart view on cardiac MRI with diffuse late gadolinium enhancement (DLGE) (yellow arrows). DLGE occurs as a consequence of regional differences in the myocardial extracellular volume and can be an indicator of an infiltrative process. (b) Tissue from an endomyocardial biopsy with apple-green birefringence under polarized light with Congo red stain (yellow arrow).
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fig1
The cardiac MRI revealed an EF of 63% by Simpson's method, normal systolic function, no regional wall abnormalities, and severe basal and midseptal hypertrophy. There was patchy, diffuse late gadolinium enhancement (DLGE) in the myocardium (Figure 1(a)). The tissue pathology from EMB revealed apple-green birefringence under polarized light with Congo red stain consistent with amyloid deposition (Figure 1(b)).