59 year old with diabetes admitted to outside hospital with volume overload and chest pain. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 231 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 41 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). The left ventricular dysfunction is global and largely related to right ventricular pressure and volume overload. There is non-specific late gadolinium enhancement in a pattern not typical of coronary artery disease to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The differential for this non-specific pattern includes previous myocarditis, sarcoidosis or other nonischemic cardiomyopathy. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated qualitatively (quantitatively EDV is normal in size indexed for BSA) with moderate-severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 261 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 183 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately 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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion. The pericardium appears to be thickened (4-6 mm) with some suggestion of adherence to the myocardium in the apical right ventricle. There is increased bowing of the interventricular septum towards the left ventricle during inspiration. These findings are suggestive of constrictive pericarditis. 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. There is pericardial thickening with some suggestion of adherence to the myocardium in the apical right ventricle and supportive findings of interventricular dependence on real time imaging. These findings are highly suggestive of constrictive pericarditis. 2. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%.The left ventricular dysfunction is global and largely related to right ventricular pressure and volume overload. There is a small amount of diffuse, non-specific late gadolinium enhancement in a pattern not typical of coronary artery disease to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is moderately dilated qualitatively (quantitatively EDV is normal in size indexed for BSA) with moderate-severely reduced systolic function. The overall RV ejection fraction is 30%