Figure 9: A 25-year-old male from Ethiopia was apparently well 5 months back when he developed a cough with mild-grade fever, treated on the lines of typhoid. He developed progressive exertional dyspnea functional class III within a month. No history of chest pain, syncope, or swelling over the limbs or face was noted. Echocardiography was suggestive of an RV tumor. CMR was performed for cardiac mass evaluation. (a) 4C cine images show RV cavity obliteration (green arrow) with dilated RA. (b) 4C LGE images show a typical “double V” sign. It consists of normal outer myocardium, marked subendocardial thickening and enhancement of RV apex (yellow arrow), and overlying nonenhanced thrombus (asterisk). (c and d) Reconstructed 3D SSFP images show nonenhancing thrombus (asterisk) occupying most of the RV cavity extending into the RV outflow tract (blue arrow). Final diagnosis: Right ventricular endomyocardial fibrosis. 3D: Three-dimensional, 4C: Four-chamber, CMR: Cardiac magnetic resonance imaging, LGE: Late gadolinium enhancement, RA: Right atrium, RV: Right ventricle, SSFP: Steady-state free precession