Introduction
Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy, characterized by left ventricular (LV) hypertrophy, in the absence of a secondary cause, with a typically asymmetric septal hypertrophy and mid-cavity obliteration phenotype [1, 2]. Spiral HCM, a rare variant, with a counter-clockwise rotation pattern of myocardial hypertrophy, typically mandates diagnosis by cardiac magnetic resonance (CMR) [3-7]. We report, to our knowledge, the first case of a spiral variant HCM visualized using routine transthoracic echocardiography (TTE). An ultrasound enhancing agent (UEA) allowed us to identify its rare geometric phenotype.