LAUSR

A 74-year-old white male was referred to the outpatient nuclear clinic by the advanced heart failure team with a history of CAD and HFrEF. Echo/Doppler exam revealed unexplained concentric thickening and an ‘‘apical sparing pattern’’. PYP imaging was requested. SPIE, UPIE and FLC revealed no evidence for a clonal abnormality. PYP imaging was completed consistent with ASNC Cardiac Amyloidosis Practice Points Bulletin. Images were interpreted as ‘‘strongly suggestive of ATTR’’. The H/CL[1.6 is consistent with a poor prognosis in this patient. Photopenic regions suggested the possibility of a camera quality assurance (QA) issue. No abnormality was identified on review of daily QA flood fields. Further investigation revealed the patient was wearing an external defibrillator with battery pack accounting for the horizontal series of circular artifact(s). The patient was referred back to the advanced heart failure team for appropriate genetic studies and therapy (Figure 1).