39 year old man with newly diagnosed LV dysfunction referred to determine etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 10%, the LV end diastolic volume index is 273 ml/m2 (normal range: 74+/-15), the LVEDV is 466 ml (normal range 142+/-34), the LV end systolic volume index is 246 ml/m2 (normal range 25+/-9), the LVESV is 419 ml (normal range 47+/-19), the LV mass index is 135 g/m2 (normal range 85+/-15), and the LV mass is 229 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a mid myocardial stripe and epicardial pattern of late gadolinium enhancement involving the septum and the inferior/inferolateral walls at the mid ventricular level. This finding suggests the presence of an underlying fibrosing infiltrative and inflammatory process. It is very atypical for prior myocardial infarction. The finding has been classically described in dilated cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 8%, the RV end diastolic volume index is 195 ml/m2 (normal range 82+/-16), the RVEDV is 332 ml (normal range 142+/-31), the RV end systolic volume index is 179 ml/m2 (normal range 31+/-9), and the RVESV is 305 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 obvious pericardial disease.Extracardiac FindingsSmall right pleural effusion with evidence of a wedge shaped infarct involving the right lower lung. 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. Severe LV dilation was severely reduced systolic function (LVEF 10%) with evidence of epicardial and mid wall fibrosis involving the entire mid left ventricle. No evidence of prior myocardial infarction. No evidence of myocardial infarction. No evidence of acute myocarditis.2. Severe RV dilation with severely reduced systolic function (RVEF 8%)3. Severe biatrial dilation4. Severe mitral regurgitation5. See extracardiac findings