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Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy presenting with ventricular apical filling, possibly containing fibrotic tissue with thrombus and/or calcification. Late gadolinium enhancement (LGE) can detect apical fibrosis in EMF patients, as a hyper intense linear image usually in a letter “V” like shape pointing to the ventricular apex. Recently, we have observed a pattern of a double layer hyper and hypo intense in LGE images, also in a “V” like shape, possibly corresponding to fibrosis plus thrombus/calcification.

A new typical finding in late gadolinium enhanced images for the diagnosis of endomyocardial fibrosis - the double V sign