Myocardial infarction showing non-ischaemic late gadolinium enhancement pattern in the mid-septum: a case report

Background Cardiac magnetic resonance (CMR) is gaining an important role in the setting of acute coronary syndromes: it gives prognostic information based on oedema and late gadolinium enhancement (LGE) extension in acute myocardial infarction, and has a diagnostic value in myocardial infarction with nonobstructive coronary arteries (MINOCA) thanks to its capability to distinguish, based on different LGE patterns, ischaemic and non-ischaemic myocardial injuries.Case summary We describe a case of acute myocardial infarction involving a recurrent apical branch showing an atypical intramyocardial LGE pattern in the medium inferior septum.Discussion An intramyocardial LGE pattern might be determined by an ischaemic injury involving the interventricular septum. The knowledge of this misleading LGE pattern is important to adequately interpret CMR findings in this clinical setting.