BackgroundCardiovascular magnetic resonance (CMR) is commonly used in patients with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) based on ECG, echocardiogram and Holter. However, various diseases may present with clinical characteristics resembling ARVC causing diagnostic dilemmas. The aim of this study was to explore the role of CMR in the differential diagnosis of patients with suspected ARVC.Methods657 CMR referrals suspicious for ARVC in a single tertiary referral centre were analysed. Standardized CMR imaging protocols for ARVC were performed. Potential ARVC mimics were grouped into: 1) displacement of the heart, 2) right ventricular overload, and 3) non ARVC-like cardiac scarring. For each, a judgment of clinical impact was made.ResultsTwenty patients (3.0%) fulfilled imaging ARVC criteria. Thirty (4.6%) had a potential ARVC mimic, of which 25 (3.8%) were considered clinically important: cardiac displacement (n=17), RV overload (n=7) and non-ARVC like myocardial scarring (n=4). One patient had two mimics; one patient had dual pathology with important mimic and ARVC. RV overload and scarring conditions were always thought clinically important whilst the importance of cardiac displacement depended on the degree of displacement from severe (partial absence of pericardium) to epiphenomenon (minor kyphoscoliosis).ConclusionsSome patients referred for CMR with suspected ARVC fulfil ARVC imaging criteria (3%) but more have otherwise unrecognised diseases (4.6%) mimicking potentially ARVC. Clinical assessment should reflect this, emphasising the assessment and/or exclusion of potential mimics in parallel with the detection of ARVC major and minor criteria.

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The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site (https://www.scmr.org) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.

In the intravenous drug user (IVDU) population, infected right-sided valvular lesions are common, and this has been well described in the literature. The Eustachian valve (also known as the valve of the inferior vena cava) is another valve in close proximity to the tricuspid valve, which can, in rare cases, be the focus of infection. Eustachian valve endocarditis may be an under-recognised complication of Staphylococcus bacteraemia in IVDU population, often only identified by transesophageal imaging. We present a case of tricuspid valve endocarditis in an IVDU with secondary seeding on the Eustachian valve, and an accompanying literature review on this rare topic.

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Background: Current guidelines suggest the use of three-dimensional left ventricular ejection fraction (3DLVEF) to assess left ventricular function, with its use favoured over Simpson's biplane method. It is also recommended that this value be cross checked with a visual estimation of left ventricular ejection fraction (LVEF). Aims: We sought to examine the accuracy of visual LVEF estimation by two experienced sonographers (SH, KS), compared to the gold standard obtained by 3DLVEF. Methods: A total of 363 consecutive patients had echocardiograms performed for a clinically indicated reason. All echocardiograms included a full volume threedimensional image acquisition from the apical windows. Both sonographers sequentially assessed visual LVEF first, then 3DLVEF on all cases in a blinded fashion. All measurements were performed using the AutoLVQ package on an EchoPac workstation. Results: Patient characteristics included age 57 ± 17 years, BMI 27.6 ± 5.9 kg/m 2 , 58% males and Simpsons biplane LVEF 58.3 ± 12.0% (range 15-87%). 3DLVEF was not considered feasible in 20% of patients and these cases were excluded from further analysis. There was an excellent correlation between visual LVEF between the two sonographers, with a Pearson's correlation coefficient r = 0.96 (95% CI 0.95-0.97), Bland Altman mean bias 0.2% (95% limits of agreement 6.9 to −7.4%). This was superior to the correlation between 3DLVEF between the two sonographers: r = 0.84 (95% CI 0.80-0.87), and between visual LVEF and 3DLVEF by each sonographer (KS: r = 0.83 [95%