Key result
CMR identifies massive septal mural thrombus mimicking hypertrophy, which regresses after 21 days of anticoagulation.
Case Report (n=1)
No
Multimodality imaging, including CMR and CT, is valuable for differentiating pseudo-hypertrophy caused by myocardial injury from true myocardial hypertrophy.
Multimodality CMR may distinguish mural thrombus from apparent septal hypertrophy; leaves open prospective validation before broader adoption.
Figure 1.Multimodality imaging illustrating the pseudo-hypertrophy pitfall on admission.A, B: Transthoracic echocardiography (TTE) in the apical four-chamber and short-axis views demonstrates apparent massive thickening of the interventricular septum (white arrows).C, D: Coronary CT angiography shows a severely hypoperfused area in the corresponding septal region (white arrowheads).E, F: Initial cardiovascular magnetic resonance (CMR) reveals an avascular endocardial dark core on late gadolinium enhancement (LGE) imaging (asterisks), matching the pseudo-hypertrophy.G: T1 mapping shows septal elevation, suggesting underlying myocardial injury.
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Inoue et al. (2026) conducted a case report in Mural thrombus mimicking septal hypertrophy (pseudo-hypertrophy) complicating suspected acute myocarditis (n=1). Anticoagulation therapy was evaluated on Resolution or reduction of the mural thrombus on follow-up imaging. Multimodality cardiovascular magnetic resonance imaging successfully unmasked a massive mural thrombus mimicking septal hypertrophy, which significantly reduced in size following 21 days of anticoagulation therapy.
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