67 year old man with history of HTN, HL, known RBBB on ECG and family history of sudden cardiac death who presented after a syncopal episode. He was referred for cardiac MRI to evaluate for structural heart disease and scar. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). Wall thickness is normal (9-10mm in the basal septum). There are no regional wall motion abnormalities present. There were technical limitations for the late gadolinium imaging portion of this exam, but grossly there is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 980ms, which is normal. There is no myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17). There are no regional wall motion abnormalities. Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta measures 37x 35mm. There is mild atherosclerosis.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly-moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.
1. Normal size LV with normal systolic function (EF 67%). Wall thickness is normal. Technically difficult late gadolinium imaging, but there is no gross evidence of late gadolinium enhancement to suggest the presence of underlying myocardial infiltration, inflammation or fibrosis. 2. Normal size RV with normal systolic function (EF 50%). There are no regional wall motion abnormalities. 3. Biatrial enlargement. 4. Main pulmonary artery dilatation. 