Fig. 2

Case of patient undergoing adenosine triphosphate (ATP) stress cardiovascular magnetic resonance (CMR). Stress perfusion (a–c), rest perfusion (d–f), late gadolinium enhancement (LGE) (g–i), left coronary artery catheter angiogram (G) and right coronary artery (RCA) catheter angiogram (H) images are illustrated. Stress induced perfusion defects (green arrows) are demonstrated in the left ventricular (LV) inferior wall on the basal and mid-ventricular slices (a, b) which resolves at rest (d, e). The left coronary artery catheter angiogram (j) shows collateral vessels coming from the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) to perfuse the RCA branches. LGE images (g–l) show no evidence of infarction. RCA coronary angiogram (k) shows the RCA is occluded. Note, that the splenic switch-off sign is present (red arrows in c, f) with the spleen unenhanced during stress and the spleen enhancing during rest