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These are the images of a previously fit 24 year old man who was found struggling for breath. He collapsed and died. He had no significant past medical history, and there was no family history of sudden death.
Panel B shows a macroscopic short axis slice of the heart, where yellow streaks can be seen in the right ventricular (RV) myocardium, most prominently in the inferior wall and the septum (arrows).
Panel A is a postmortem turbo spin echo magnetic resonance image of the same slice, which shows an increased signal intensity in the RV myocardium corresponding to the yellow streaks seen on the macroscopic specimen (arrows).
Panel C shows a histopathologic specimen stained with haematoxylin-eosin taken from the RV of the same heart. Large numbers of adipocytes (yellow) are seen within the RV myocardium, especially subendocardially, as well as remaining cardiomyocytes (red).
Panel D demonstrates how adipocytes stained yellow are interspersed with remaining cardiomyocytes. Note also the increased amount of collagen stained red indicating fibrosis. Trichrome stain.