Focal right ventricular apical hypertrophy or apical muscular ventricular septal defect

A 28-year-old male patient was referred to our imaging center with the differential diagnosis of a right ventricular (RV) apical mass. He was a known case of the ventricular septal defect (VSD) with a history of spontaneous closure at the age of 2 years. His chief complaint was chest pain and palpitation. He was referred with a transthoracic echocardiography report of RV apical hypertrophy with almost apical obliteration or RV apical mass. Cardiovascular magnetic resonance imaging demonstrated few intramyocardial crypts of basal anteroseptal left ventricular (LV) segment. There was no evidence of concomitant LV apical hypertrophy. Indeed, there was a small conical- and tunnel-shaped serpiginous apical-infundibular muscular VSD (3.6 mm RV side's diameter and 7.6 mm LV side's diameter) resulted in a localized and severely hypertrophied RV apical segment and no significant shunt (QP/QS: 1.16). There was no evidence of other cardiac mass.