59 year-old man with newly diagnosed heart failure, LVEF severely reduced on echocardiogram and normal coronaries is sent for MRI to evaluate for possible myocarditis. Left VentricleThe left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 323 ml (normal range 142+/-34), the LV end systolic volume index is 115 ml/m2 (normal range 25+/-9), the LVESV is 282 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 246 g (normal range 164+/-36). There is global hypokinesis. Hyperenhancement noted on T2 stir imaging in the basal inferior, inferolateral and lateral walls suggestive of acute myocardial inflammation. This could be consistent with active myocarditis. There is no hyperenhancement noted in the septum in the region where an RV biopsy would be performed. There is also hyperenhancement of the pericardial space and possibly pericardium in this area. Loculated small collection of pericardial fluid noted also in the same area. There is patchy basal inferior, infero-lateral and mid-lateral late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with myocardial infarction and could be consistent with myocarditis . Native myocardial T1 time 1090 msec.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately 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 drain normally into the right atrium.PericardiumLoculated, basal pericardial effusion. Hyperenhancement on T2 stir of the basal pericardial sac suggestive of pericarditisExtracardiac FindingsInterstitial changes noted in the lungs. Minimal bilateral pleural effusions. 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 moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%. There is global hypokinesis.2. Hyperenhancement noted on T2 stir imaging in the basal inferior, inferolateral and lateral walls suggestive of acute myocardial inflammation. This could be consistent with active myocarditis. There is patchy basal inferior, infero-lateral and mid-lateral late gadolinium enhancement suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with myocardial infarction and could be consistent with myocarditis.3. No hyperenhancement noted in the septum in the region where an RV biopsy would be performed.4. The right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 37%5. Biatrial enlargement6. Loculated pericardial effusion noted at the base of the LV. Hyperenhancement on T2 stir imaged suggestive of pericarditis.7. See extra-cardiac findings. 8. The constellation of findings in this study are highly suggestive of myo-pericarditis. 