CASE REPORT
A 42-year-old male diagnosed with HCM previously, was referred our cardiac magnetic resonance (CMR) unit for evaluation of myocardial scarring and risk stratification by means of late gadolinium enhancement (LGE). His chief complain was increasing shortness of breath and was on active surveillance for prior lung adenocancer. ECG showed no significant abnormalities. Previous echocardiography exams showed hypertrophic septal cardiomyopathy with maximum wall thickness of 21 mm. Current echocardiography exam showed mass-like thickening of the septal myocardium which nearly obscured the RV cavity (Figure 1, Movie 1). CMR showed significant wall thickening in the LV septum and apex. T1 and T2 weighted images showed that the thickened segment was isointense to normal myocardium (Figure 2, Movie 2). Mid to apical left ventricular and right ventricular cavity was obliterated due to its mass effect. First-pass perfusion study with gadolinium showed a large, mass-like appearance of the thickened myocardium and the mass had necrotic center (Movie 3). LGE images confirmed the large myocardial mass and its necrotic center (Figure 3). The findings were most consisted with myocardial metastasis.