Differential Diagnosis for Typical Hinge Point Late Gadolinium Enhancement

• Single most likely diagnosis
  • Right ventricular pressure overload: This condition is a plausible explanation for the late gadolinium enhancement (LGE) pattern described, especially given the normal thickness of the ventricular and septal walls. The "hinge point" pattern can be associated with areas of increased stress or pressure, which aligns with the pathophysiology of right ventricular pressure overload.
• Other Likely diagnoses
  • Genetic positivity for hypertrophic cardiomyopathy without anatomic sequelae: Individuals with a genetic predisposition to hypertrophic cardiomyopathy (HCM) may exhibit LGE patterns typical of HCM, such as the hinge point pattern, even in the absence of overt hypertrophy. This could be an early sign or a variant expression of the disease.
  • Dilated cardiomyopathy: Although less common, dilated cardiomyopathy has been associated with LGE, including patterns that might resemble the hinge point distribution. The absence of significant ventricular dilation in this case does not entirely rule out this diagnosis, as LGE can precede significant chamber enlargement.
• Do Not Miss diagnoses
  • Arrhythmogenic right ventricular cardiomyopathy (ARVC): This condition is characterized by fibrofatty replacement of the right ventricular myocardium and can present with LGE on cardiac MRI. It is a critical diagnosis to consider due to its association with life-threatening arrhythmias and the potential for sudden cardiac death.
  • Cardiac sarcoidosis: Although not directly mentioned, cardiac sarcoidosis can cause LGE patterns that might mimic other conditions. It is a "do not miss" diagnosis due to its potential for significant morbidity and mortality, particularly if untreated.
• Rare diagnoses
  • Other infiltrative cardiomyopathies (e.g., amyloidosis, Fabry disease): These conditions can also lead to LGE on cardiac MRI, though they might not typically present with a hinge point pattern. They are rare but important to consider in the differential diagnosis due to their distinct management and prognosis.
  • Myocardial fibrosis from other causes (e.g., myocarditis, chemotherapy-induced cardiomyopathy): Various conditions can lead to myocardial fibrosis, which might be visualized as LGE on MRI. While these might not be the first considerations, they remain part of the broad differential diagnosis for LGE patterns.