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Advanced CMR with T1 mapping later reclassified the dyskinetic segment as a benign anatomical variant\u2014a \u201cbutterfly apex\u201d\u2014and confirmed isolated epicardial fat without myocardial infiltration. Over long-term follow-up, no arrhythmias or structural progression occurred. The case highlights the critical role of multimodal imaging in differentiating ACM from benign anatomical mimics, thereby preventing misdiagnosis and unnecessary intervention.<\/jats:p>","DOI":"10.4103\/jcecho.jcecho_136_25","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:00:19Z","timestamp":1777406419000},"page":"66-69","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Navigating the Challenges of Diagnosing Arrhythmogenic Cardiomyopathy"],"prefix":"10.4103","volume":"36","author":[{"given":"Leonardo","family":"Brugiatelli","sequence":"first","affiliation":[{"name":"Department of Cardiology, Intensive Care Unit, AST 1, Pesaro Hospital, Pesaro, Italy"},{"name":"GM Lancisi Cardiovascular Centre, Marche University Hospital, Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Lofiego","sequence":"additional","affiliation":[{"name":"GM Lancisi Cardiovascular Centre, Marche University Hospital, Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Capodaglio","sequence":"additional","affiliation":[{"name":"GM Lancisi Cardiovascular Centre, Marche University Hospital, Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Vagnarelli","sequence":"additional","affiliation":[{"name":"GM Lancisi Cardiovascular Centre, Marche University Hospital, Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"R1-20260429","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijcard.2020.06.005","article-title":"Diagnosis of arrhythmogenic cardiomyopathy: The Padua criteria","volume":"319","author":"Corrado","year":"2020","journal-title":"Int J Cardiol"},{"key":"R2-20260429","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1093\/ehjci\/jet095","article-title":"Is it really fat? 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