Epicardial lipomatous hypertrophy (ELH) is a rare histologically benign condition characterized by excessive accumulation of epicardial fat. We report a case of a 68-year-old female who experienced reduced effort tolerance for the past year. A transthoracic echocardiogram revealed a suspicious circumferential mass around the heart. Cardiac magnetic resonance (CMR) was subsequently performed and identified a 13- to 15-mm-thick layer of epicardial fat surrounding the myocardium, with a small pericardial effusion at the lateral wall. Cardiac function was preserved, and her symptoms were ultimately attributed to atherosclerotic coronary disease, which was treated accordingly. This case highlights the importance of using complimentary multimodal imaging such as CMR, to differentiate between ELH and others, for accurate diagnosis and further management.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is primarily a familial disease with autosomal dominant inheritance. Incomplete penetrance and variable expression are common, resulting in broad disease spectrum. Three patterns of phenotypic expression have been described: (1) “classic” subtype, with predominant right ventricle involvement, (2) “left dominant” subtype, with early and dominant left ventricle involvement, and (3) “biventricular” subtype, with both ventricles equally affected. Genotypephenotype associations have been described, but there are other genetic and non-genetic factors that can affect disease expression. We describe two different phenotypic expressions of ARVC in a family.