76 year old male with known CAD, has had noted cecrease in LV EF, MRI done to assess. MEDICATIONS: Amlodipine, atorvastatin, carvedilol, clopidogrel, lisinopril, hydrochlorothiazide, spironolactone First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is presence of late gadolinium enhancement in the mid and basal anterior wall, the apical anterior and apical inferior, and basal and mid anterolateral wall, involving up to 50% of the LV wall thickness, suggesting prior myocardial infarction.Left VentricleThe left ventricle is normal in size with mildly decreased ejection fraction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 202 ml (normal range 142+/-34), the LV end systolic volume index is 54 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 67 g/m2, and the LV mass is 138 g. There is hypokinesis in the mid anterior, mid anterolateral wall and apical cap of the ventricular myocardial wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 210 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 116 ml (normal range 54+/-17).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 trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings11.3 x 4.4 cm T2 hyperintense mass in the right axillary region on image 14 of series 201 with internal hypointense lesion or laterally which measures 4.1 x 1.6 cm. 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.
Unexpected right axillary, fat-containing mass with probable soft tissue component, as above. Further evaluation with dedicated, gadolinium-enhanced chest wall mass MRI suggested.1. No perfusion defects/ "ischemia" present during hyperemia.2. There is presence of late gadolinium enhancement in the mid and basal anterior wall, the apical cap, and basal and mid anterolateral wall, involving up to 50% of the LV wall thickness, consistent with prior myocardial infarction. There is hypokinesis in the mid anterior, mid anterolateral wall and apical cap of the ventricular myocardial wall. 3. Normal LV size and mildly decreased systolic function (LVEF 46%).4. Normal RV size and systolic function (RVEF 45%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.