A 63 year old male with history of Lymphoma, s/p chemotherapy 20 years ago, intersitial lung disease, paroxysmal atrial fibrillation, chronic systolic heart failure. Referred to cardiac MRI for evaluation of function and etiology. 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 48 ml/m2 (normal range: 74+/-15), the LVEDV is 96 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 20 g/m2 (normal range 85+/-15), and the LV mass is 40 g (normal range 164+/-36). There is mild hypokinesis at the basal to apical segments of the inferoseptal and inferior walls. There is dys-synchronic myocardial contraction. There is late gadolinium enhancement at the inferior and inferoseptal walls at the mid and apical segments in a mid wall/subepicardial pattern These gadolinium enhancements are atypical for myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.T1 times were mildly increased at the mid and apical septum (range between 1080-1100).No iron overload was noted.No intracavitary thrombus was noted.Left AtriumThe left atrium is normal in size (90ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is question of trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (35 x 37 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (27 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is prominent pericardial fat.Extracardiac FindingsCalcified mediastinal lymph nodes, specifically within the anterior mediastinum, most consistent with treated lymphoma.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. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 48%. There is mild hypokinesis at the basal to apical segments of the inferoseptal and inferior walls. There is dys-synchronic myocardial contraction. 2. There is mild late gadolinium enhancement at the inferior and inferoseptal walls at the mid and apical segments in a mid wall/subepicardial pattern. These gadolinium enhancements are atypical for myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. T1 times were mildly increased at the mid and apical septum.3. No iron overload was noted.4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 48%.