Impression:
Marked fixed reduced uptake in the inferior wall from base to apex, extending into the lateral wall apically (white arrows) -- consistent with mixed transmural / nontransmural MI (RCA territory). No significant additional fill-in in delayed images to indicate hibernating myocardium in this region.
Mild reduced uptake in the apical-anterior wall at rest with late fill-in (green lines) -- consistent with some hibernating myocardium in these segments.
High pulmonary TL uptake during stress (green arrows) -- consistent with stress-induced LV failure. This high lung uptake may contribute to the impression of increased uptake in the apical-anterior segments with stress (green lines).
Planar images, anterior projection:
Stress (left) and Delayed (right)
Notice the very high lung uptake above the heart on the left side (lung / heart ratio 0.78, normal <0.50).
