53-year-old male with a past history of CVA, tobacco abuse, possible alcoholic cirrhosis who presented with chest pain and shortness of breath, elevated troponin and BNP, ECG changes consistent with NSTEMI. Referred for a cardiac MRI to evaluate etiology of regional hypokinesis of the left ventricle in the setting of no significant coronary artery disease on cardiac catheterization. Left VentricleThe left ventricle is normal in size with moderate to severely depressed function. The overall LV ejection fraction is 30%. The LVEDV is 177 ml (normal range 142+/-34), the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVESV is 125 ml (normal range 47+/-19) and the LV end systolic volume index is 74 ml/m2 (normal range 25+/-9). The LV mass is 122 g (normal range 164+/-36) and the LV mass index is 73 g/m2 (normal range 85+/-15). There are wall motion abnormalities noted in the inferior, inferolateral and lateral walls (mid ventricular segments). There is a increased signal noted on T2 STIR imaging in the mid inferolateral, lateral walls suggestive of inflammation or edema in this area of the myocardium. There is mostly transmural late gadolinium enhancement in the mid inferior, base to mid inferolateral and lateral walls. This pattern of late gadolinium enhancement is consistent with myocardial infarction. There are also areas of microvascular obstruction noted in the inferolateral wall. Left AtriumThe left atrium is mild-moderately enlarged. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%. The RVEDV is 113 ml (normal range 142+/-31), RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVESV is 57 ml (normal range 54+/-17), and the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate left-sided pleural effusion. 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.Normal-sized left ventricle with moderate to severely depressed function. LVEF 30%. 2.There are wall motion abnormalities noted in the inferior, inferolateral and lateral walls (mid ventricular segments). 3.There is a increased signal noted on T2 STIR imaging in the mid inferolateral, lateral walls suggestive of inflammation or edema in this area of the myocardium. 4.There is mostly transmural late gadolinium enhancement in the mid inferior, base to mid inferolateral and lateral walls. This pattern of late gadolinium enhancement is consistent with myocardial infarction. 5.There are areas of microvascular obstruction noted in the inferolateral wall. 6.Normal sized right ventricle with mildly depressed function. RVEF is 49%.7.Mild to moderate tricuspid regurgitation.8.These constellation of findings are suggestive of recent myocardial infarction. Given the normal coronary angiogram these findings could be consistent with an embolic event. Clinical correlation required.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.