Adult Congenital

Case 242 - Dot-Like Myocardial Septal Enhancement

An unusual pattern of dot-like enhancement on 4C in the septum should alert us to look for this condition on CMR (prominent vessels, collateral vessels, infarcts) and altered patterns of perfusion and ischemia on stress CMR

Bhavin Jankharia

Apr 9, 2026 — 2 min read

30-years old had clinical evidence of ischemia and angiography showed a specific anomaly. He was sent for a stress cardiac MRI.

Scar mid and apical anterior wall - Linear and dot-like signal in septum on 4C

Mid-myocardial linear enhancement, Scar mid and apical anterior wall, Dot-like enhancement in septum

The stress perfusion shows inducible ischemia in the LAD territory, but the rest perfusion showed interesting findings as below.

Linear and dot-like signal and enhancement in septum on 4C
Scar - mid and apical anterior wall
Mid-myocardial linear enhancement
Ischemia at rest in the septum with inducible ischemia in other segments of the LAD territory
Retrograde filling of the LAD via collaterals

The video describes the case, the findings and the final diagnosis.

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