(A) Rest and stress myocardial perfusion scintigraphy demonstrates a large, moderately severe defect of the inferior left ventricular wall that appears identical on both resting and post-stress images (arrows). (B) Rest and stress polar maps and surface renderings display the same nonreversible abnormality (arrows). A mild anterior wall decrease at rest is not present at stress, consistent with mild chest wall attenuation (circle).

Differential Diagnosis

•  Diaphragm attenuation artifact: Fixed inferior wall defects with normal wall motion are most commonly due to this artifact.

•  Inferior myocardial infarction: This would look identical on these images (a nonreversible defect). However, an infarct this large should have an associated wall motion abnormality.

•  Hibernating inferior myocardium: