Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder of the heart muscle characterised pathologically by replacement of the right ventricular myocardium with fatty or fibrous fatty tissue. Recently, because of its excellent spatial and temporal resolution, 16 row multislice computed tomography (CT) has received much attention as a non-invasive method of diagnosing cardiac disorders. Its usefulness in the diagnosis of the ARVC has not been previously reported.

We present the case of a 33 year old woman with a history of palpitations. The ECG showed sinus rhythm and right bundle branch block. An atypical auricular flutter was reported. The echocardiogram showed discrete right ventricular dilatation and hypocontractile areas but not conclusive images of ARVC.

Cardiac 16 row multislice CT was performed and showed the enlarged myocardial trabeculae, particularly on the anterior and inferior walls, which explains the angiographic images of deep fissures. A scalloped appearance of the free wall of the right ventricle corresponds to the finding of localised akinetic or dyskinetic bulges seen at the apex, infundibulum, and inferior wall.

Left: Reformatted image in short axis scan showing enlarged myocardial trabeculae. Right: Reformatted image in short axis scan show bulging of the inferior wall (arrows), which is compatible with aneurysm formation and is pathognomonic for ARVC. LA, left atrium; LV, left ventricle; RV, right ventricle.

Slightly scalloped appearance of the right ventricle in volume rendering reconstruction. Arrows show slight bulging of the anterior wall of the right ventricle with ARVC.