43 year old woman with DLBCL, referred for evaluation of constrictive pericarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 181 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 92 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 97 g (normal range 114+/-24). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying replacement fibrosing, infiltrative, or inflammatory process. There is a moderate increase (in native myocardial T1 diffusely throughout the left ventricle suggesting the presence of interstitial myocardial fibrosis. The native myocardial T1 time is 1187ms, the LV T1 time is 1702ms. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. 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 aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThe pericardium is thickened (about 6mm) circumferentially around the entire heart. Based on myocardial tagging, there is pericardial to myocardial tethering most pronounced along the basal left ventricle. A "septal bounce" (which is most pronounced with inspiration) is present and indicative of ventricular interdependence and the diagnosis of pericardial constriction. The majority of the pericardium has late gadolinium enhancement present but without increased T2-signal, indicative of pericardial fibrosis. No significant pericardial effusion is noted. Extracardiac FindingsThere are moderate to large bilateral pleural effusions. This 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. There is evidence of significant pericardial thickening with evidence of chronic pericardial constriction as described above.2. The left ventricle is normal in size with mildly reduced systolic function (LVEF 49%) without evidence of late gadolinium enhancement to suggest the presence of underlying myocardial replacement fibrosis, inflammation, or infiltration. However, the native myocardial T1 time is moderately elevated diffusely, suggesting the presence of interstitial fibrosis. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%. 4. Moderate to large bilateral pleural effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.