Impression:
Nontransmural MI in the inferolateral wall (arrows), with moderate-to-severe ischemia in the residual myocardium (small lines) (6/25 segments) (LCX territory).
Marked "increase" in LV volume with stress.
ECHO:
Mild concentric LV hypertrophy
Normal chamber dimension
LVEF - 55-60%
Comments:
The explanation for what appears to be an "increase" in the LV volume is indeed ischemia, which is usually most pronounced in the subendocardium.
In this case, there is subendocardial MI in the lateral wall and stress-induced ischemia in the residual myocardium leading to the very assymetric change in LV configuration during stress, simulating increase in cavity size.
