83 year old woman with history of hypertension, breast cancer and ALL s/p chemotherapy with worsening LVH and diastolic dysfunction on echocardiogram; referred for cardiac MRI to evaluate for possible amyloidosis or infiltrate cardiomyopathy. Left VentricleThe left ventricle is normal sized with mildly reduced systolic function. There is LVH; on the 3 chamber view at end diastole, the anterior septum measures 23 mm. The basal inferolateral wall measures 18 mm. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 84 g/m2 (normal range 67+/-11), and the LV mass is 172 g (normal range 114+/-24). There is hypokinesis of the basal segments, with preserved apical wall motion. There are diffuse, mid myocardial areas of intermediate late gadolinium enhancement involving the septum, lateral, anterior and basal inferior walls. There is late gadolinium enhancement in the right ventricular wall, as well as left atrium and adjacent to the mitral apparatus. There is shortening of the T1 inversion time post gadolinium administration. These findings are suggestive of an infiltrative process, such as amyloidosis. No intracardiac thrombus is present.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 83 ml (normal range 35+/-13). Enhancement is demonstrated by the right ventricular wall in the mid myocardial distribution, atypical for infarct.Right AtriumThe right atrium is moderately severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC appears dilated.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, right greater than left. There is focal high signal within the left lower lobe, suggestive of aspiration. This is new since the radiograph of May 2015.
1. Impaired left ventricular systolic function with EF 49%, and relative hypokinesis of the basal segments. There is basal LVH. Diffuse mid myocardial enhancement throughout the left ventricle, right ventricular free wall and left atrium. Findings are compatible with cardiac amyloidosis.2. Reduced right ventricular systolic function with EF 37% 3. Biatrial dilatation. 4. Trivial mitral regurgitation and mild tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.