A 47 year old male with ventricular tachycardia referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is in the upper limit of normal range for size with low-normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 218 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 135 g (normal range 164+/-36). There is subtle global hypokinesis with regional variation. There is focal late gadolinium enhancement at the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1-times are mildly increased at the base inferolateral wall (~1100ms). These findings are compatible with an old inflammatory process (myocarditis) and not with myocardial infarction.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (100ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 105 ml/m2 (normal range 82+/-16), the RVEDV is 244 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 120 ml (normal range 54+/-17). No fatty infiltration of the myocardium, no aneurysm or regional wall abnormalities were seen. No MRI findings to support the diagnosis of ARVD.Right AtriumThe right atrium is normal in size.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 mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings4.2 cm solid lesion within the mid inferior pole of the left kidney.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. 4.2 cm solid lesion within the mid inferior pole of the left kidney, highly worrisome for renal cell carcinoma. 2. The left ventricle is in the upper limit of normal range for size with low-normal systolic function, the LVEF is 50%. There is subtle global hypokinesis with regional variation. 3. There is focal late gadolinium enhancement at the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1-times are mildly increased at the base inferolateral wall. These findings are compatible with an old inflammatory process (myocarditis) and not with myocardial infarction.4. The left atrium is mildly dilated. 5. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. No fatty infiltration of the myocardium, no aneurysm or regional wall abnormalities were seen. No MRI findings to support the diagnosis of ARVD.Dr Tung was notified by email about the findings by email.