Cardiothoracic Imaging| Volume 95, P80-89, March 2023

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Hypertrophic cardiomyopathy - phenotypic variations beyond wall thickness


      • There are several morphological features besides left ventricular hypertrophy which can suggest a diagnosis of Hypertrophic Cardiomyopathy (HCM)
      • A spade-shaped appearance of the left ventricle is characteristic of apical HCM
      • In patients with HCM, there may apical displacement of the papillary muscles, papillary muscle hypertrophy, and elongation of the mitral leaflets which may lead to outflow tract obstruction
      • Myocardial crypts and left ventricular bands are variants associated with HCM
      • In HCM, dystrophic calcifications may result from decreased microvascular perfusion pressure and ischemia.


      Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy (LVH) in the absence of another causal disease. Several morphologic and histologic changes have been described. Given the morbidity and mortality associated with HCM, understanding these anatomic variations is key to interpreting imaging. This is especially important since many patients exhibit these associated findings in the absence of LVH and prompt early detection of these variations may lead to early diagnosis and treatment. This article describes the appearance of morphologic variations seen in HCM beyond myocardial thickening including: papillary muscle and mitral valve variants, myocardial crypts, left ventricular myocardial bands, and dystrophic calcification related to increased wall tension.


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