88 year old with cardiomyopathy presenting for evaluation of left ventricular systolic dysfunction. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. There is a mild sigmoid septum. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 176 ml (normal range 109+/-23), the LV end systolic volume index is 62 ml/m2 (normal range 18+/-5), the LVESV is 106 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There is hypokinesis of the mid to apical anterior and anteroseptal walls. There is a mid myocardial "stripe" of late gadolinium enhancement involving the basal septum. This is seen as a typical finding in nonischemic cardiomyopathy (dilated or previous myocarditis). Additionally, the native T1 times are elevated at 1150 ms (normal < 1050 ms) which suggests mild diffuse underlying myocardial fibrosis or edema. Left AtriumThe left atrium is mildly to moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 110 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild to moderate atherosclerosis in the descending thoracic aorta.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 a trivial pericardial effusion. There is pericardial fat present. Extracardiac FindingsThere is a large pleural-based, heterogenous, mass (35 x 32 mm) on the right lateral mid lung and another smaller mass in right lung field. There is a right renal complex exophytic mass. 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. Lung and renal mass as above, recommend dedicated imaging if clinically indicated. 2. Moderate left ventricular dilation with moderately reduced systolic function (LVEF 40%) with mid to apical hypokinesis of the anterior and anteroseptal walls. There is additionally late gadolinium enhancement of the basal septum in the mid-wall stripe pattern, which is suggestive myocardial fibrosis or inflammation. The pattern has been described in both myocarditis and non-ischemic cardiomyopathy. 3. Normal right ventricular size and systolic function (RVEF 52%).4. Mild to moderate left atrial dilation. 