16-year-old female with chest heaviness, new reduced EF Clinical TTE. Evaluate for signs of myocarditis. Left VentricleFrequent ectopy limits quantification of ejection fraction. Wall motion is suggestive of frequent premature ventricular contractions during the entire examination. The left ventricle is visually normal in size. The LV systolic function is globally, mildly reduced. The overall LV ejection fraction is approximately 42%.On the short-axis view, there is minimal high signal intensity of the mid myocardium at the mid chamber of the inferior wall compatible with enhancement. This is a focal, limited to the inferior wall. No other enhancement is identified, specifically no enhancement is identified at the interventricular septum.No intracardiac thrombus is present.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is mildly dilated. The RV systolic function is moderately reduced. The overall RV ejection fraction is 35%.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 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 are normal in size and drain normally into the right atrium. PericardiumNo significant pericardial effusion, pericardial enhancement or thickening.
There is a linear mid myocardial high signal at the inferior wall at the mid chamber of the left ventricle. This is compatible with limited gadolinium enhancement. There is global, mildly reduced systolic function with an approximate left ventricular ejection fraction of 42%. Preventricular contractions are noted throughout the entire examination. The wall motion abnormality is disproportionate to the extent of enhancement.The right ventricle and atrium appear mildly dilated; no associated enhancement of the right ventricle is noted. The constellation of imaging findings, along with negative serology at the time of imaging, raises a question of a remote or subacute myocarditis with possible remodeling of the right ventricle. The ventricular ectopy may be related to prior inflammation.Dedicated imaging does not suggest pericardial inflammation at this time. The results were discussed with Dr. Arredondo.