Clinical introduction A previously healthy 38-year-old man presented with a 3-month history of progressive dyspnoea and ventricular tachycardia (VT). He suffered a viral illness 4 months earlier. There was no family history of cardiac disease or sudden cardiac death (SCD). ECG showed left bundle branch block (LBBB). Echocardiography revealed a dilated left ventricle with severely impaired systolic function. Coronary angiogram showed angiographically normal coronary arteries. He was diagnosed as having dilated cardiomyopathy and was referred for further assessment with cardiovascular magnetic resonance (CMR) (figure 1) and subsequently CT thorax.
Question What is the most likely diagnosis?
Dilated cardiomyopathy secondary to HIV
Granulomatosis with polyangiitis (GPA)
Underlying malignancy with lung and cardiac metastases
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Contributors ACL wrote the manuscript. CER and RM reviewed and interpreted the imaging. All authors approved the final manuscript.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.