A 37 year old male with end stage renal disease on dialysis, hypertension, with repeated admission due to chest pain and pulmonary edema. An echocardiography (4/2015) showed hyperdynamic systolic function with severe left ventricular hypertrophy. Now hospitalized and referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 208 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 161 g/m2 (normal range 85+/-15), and the LV mass is 290 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. No myocardial iron overload is noted.No intracavitary thrombus is noted.In the context of this patient, these findings support the diagnosis of cardiac amyloid.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 80 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 ValveThere is dense calcification along the inferolateral mitral annulus with low density within the central portion of calcification which is demonstrated on recent CT. This is shown on MRI with low signal on the steady-state free precession sequences. This low density in the central calcification is suggestive of caseous necrosis. This contributes to slight decreased excursion of the basal posterior leaflet of the mitral valve. No significant mitral stenosis is visualized.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.PericardiumThere is no pericardial effusion.Extracardiac FindingsIron overload is noted in the liver. Previous mediastinal lymphadenopathy from CT 7/15 does not appear as prominent on the current examination.
1. The left ventricle is moderately dilated with hyperdynamic systolic function, the LVEF is 72%. There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. In the context of this patient, these findings support the diagnosis of cardiac amyloid.2. The left and right atrium are dilated. 3. The right ventricle is mildly dilated with normal systolic function, the RVEF is 62%.4. Evidence of iron deposition in the liver and possibly in the spleen.