Differential diagnosis of thickened myocardium: an illustrative MRI review

Cristina Méndez,Rafaela Soler,Lorenzo Monserrat,Esther Rodríguez,Juan Pablo Ochoa,Roberto Barriales

doi:10.1007/s13244-018-0655-9

Abstract

ObjectivesThe purpose of this article is to describe the key cardiac magnetic resonance imaging (MRI) features to differentiate hypertrophic cardiomyopathy (HCM) phenotypes from other causes of myocardial thickening that may mimic them.ConclusionsMany causes of myocardial thickening may mimic different HCM phenotypes. The unique ability of cardiac MRI to facilitate tissue characterisation may help to establish the aetiology of myocardial thickening, which is essential to differentiate it from HCM phenotypes and for appropriate management.Teaching points• Many causes of myocardial thickening may mimic different HCM phenotypes.• Differential diagnosis between myocardial thickening aetiology and HCM phenotypes may be challenging.• Cardiac MRI is essential to differentiate the aetiology of myocardial thickening from HCM phenotypes.

Highlights

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder worldwide, with a prevalence of 1 in 500 in the general population [1]
Cardiac magnetic resonance imaging (MRI) is essential to differentiate the aetiology of myocardial thickening from HCM phenotypes
It is characterised by an unexplained left ventricular (LV) hypertrophy in the absence of other disease entities that may lead to inappropriate myocardial wall thickening caused by pressure/volume overload, infiltrative disorders, athlete’s heart or neoplastic infiltration [2,3,4,5]

Summary

Conclusions

Familiarity with the spectrum of myocardial thickening mimickers allows consideration of the differential diagnosis of HCM. Understanding relevant clinical features, the myocardial thickening location and distribution patterns of late gadolinium enhancement facilitates the recognition of key cardiac MRI features, which can allow identification of those causes of myocardial thickening that may mimic the various HCM phenotypes

Introduction

Findings