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Takotsubo cardiomyopathy (TC) is a reversible condition in which there is transient left ventricular (LV) dysfunction characterised most commonly by basal hyperkinesis and mid-apical LV ballooning and hypokinesia. It is said to be triggered by stress and mimics, such as acute coronary syndrome (ACS) clinically. Diagnosis is usually suspected on echocardiography due to the characteristic contraction pattern in a patient with symptoms and signs of ACS but normal coronary arteries on catheter angiography. Cardiac magnetic resonance (CMR), with its latest advancements, is the diagnostic modality of choice for diagnosis, prognosis and follow-up of patients. The advances in CMR (including T1, T2, ECV mapping and threshold-based late gadolinium enhancement (LGE) measurements have revolutionised the role of CMR in tissue characterisation and prognostication in patients with TC. In this review, we highlight the current role of CMR in management of TC and enumerate the CMR findings in TC as well the current advances in the field of CMR, which could help in prognosticating these patients.

Intra-atrial, intracameral or intracavitary right coronary artery (IARCA) is a rare anomaly in which a segment of the right coronary artery (RCA) courses through the right atrial chamber. Radiologically, IARCA is defined as a segment of RCA that is entirely surrounded by intracavitary contrast in all phases of the cardiac cycle. It was initially described only in post mortem specimens and during cardiac surgeries with an incidence varying between ~0.1% and 1.8% (1, 2). Although current evidence points to it being a benign and incidental anomaly, its importance lies in its identification prior to ablative procedures for arrhythmias, catheterization of the right-sided chambers, and pacemaker implantation. With the indications for patients requiring the above procedures expanding rapidly, it is imperative to identify this anomaly pre-procedurally, as the risk of injury to the intracavitary coronary arterial segment is high. The injury can be thermal damage due to proximity to the ablation tip or due to entanglement during catheterization. IARCA can be detected reliably by using computed tomography coronary angiography (CTCA) and recent studies using CTCA have consistently detected a relatively higher prevalence rate as opposed to earlier studies due to its superior and improved image resolution (3, 4). As we increasingly shift from invasive coronary angiographies to non-invasive cross-sectional modalities, their diagnosis is bound to increase. The advent of dual-source CT scanners has led to tremendous developments in the field of cardiac imaging due to their higher temporal and spatial resolution. The purpose of this study was to identify the prevalence and characteristics of IARCA in the adult population undergoing CTCA on a dual-source CT scanner. PURPOSEWe aimed to determine the prevalence rate and radiological characteristics of intra-atrial right coronary artery (IARCA) in an adult population undergoing computed tomography coronary angiography (CTCA) on a dual-source CT scanner. METHODSOverall, 7114 consecutive CTCAs acquired using a dual-source CT scanner in a high-volume, specialized cardiac care facility were retrospectively analyzed for the presence of IARCA. We scrutinized the CTCA datasets to determine the prevalence rate of IARCA and also to characterize its various imaging features including its length, depth from right atrial wall, segment involved, and presence and absence of atherosclerosis within the involved segment and in the rest of the right coronary artery (RCA). RESULTSThe prevalence of IARCA was 0.29% (21/7114) in our study population. The mean length and depth of the intra-atrial segment was 14.85 mm and 2.57 mm, respectively. The mid-RCA was the most common segment to be involved, and no significant atherosclerosis was noted either in the intra-atrial segment or the rest of the RCA. CONCLUSIONThe prevalence rate of the incidental IARCA in the adult subjects undergoing CTCA is higher than previously reported for anatomical series, as seen in our study using a dual-source scanner. This under...

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Cardiac outpouchings pose a diagnostic challenge when encountered in practice, as the signs, symptoms, and initial investigations, such as radiographs and electrocardiogram, are nonspecific. They may remain asymptomatic and be incidentally detected. However, a few may present with progressive shortness of breath, thromboembolic complications, arrhythmias, pressure effects, rupture, or even death. Imaging is of paramount importance in establishing an accurate diagnosis, delineating morphology and extent of the lesion along with its hemodynamic significance, planning management, and in the follow-up.