New shortness of breath on exertion with no past medical history. [Chest] [XR] [MR]

59 year old with no past medical history, now with new dyspnea on exertion.

Top: Chest radiographs show development of cardiomegaly since 6 years prior. The pulmonary vascular markings are also more prominent than before, suggesting pulmonary congestion.

Bottom: MRI Cine FIESTA sequences in the 4- and 2-chamber views at end-diastole. There are prominent trabeculations towards the cardiac apex at both the left and right ventricles. In particular, there is an outer layer of dense myocardium and a thicker inner layer of trabeculated myocardium.

Final Diagnosis: Cardiac noncompaction.

Comparison Case: Meth-Induced Cardiomyopathy.

Cardiac noncompaction is a genetic disorder leading to failure of the myocardium to form "compact" walls. It is extremely rare. The presentation depends on how bad the noncompaction is, so can be asymptomatic to heart failure, arrhythmias, and thromboembolism.