D.D.of delayed cardiac enhancement

1-Normal cardiac enhancement should starts early and shows wash out early.

2-If it shows delayed wash out after 10-15 minutes, this will suggests injured myocardium.

3-Look to this delayed wash out according to its distribution.

4-If it is distributed along territory of a coronary artery, and affect first subendocardial area followed by trans mural area---Your diagnosis should be ischemic cardiomyopathy.(look also for hypertension or valvular disease in the history or examination).

5-If it is not distributed along territory of a coronary artery, and affects mid wall or epicardial area rather than subendocardial area, think immediately for non ischemic cardiomyopathy especially if there is no evidence of hypertension or valvular diseases.

6-Most common cause of non ischemic cardiomyopathy is amylodosis.