51 year old woman with SLE, new heart failure referred for evaluation of myocarditis. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 103 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 69 ml/m2 (normal range 18+/-5), the LVESV is 112 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 103 g (normal range 114+/-24). LV dysfunction is global with regional variation. There is extrinsic compression of the lateral wall by heavily stool filled loops of bowel in the abdomen. On T2 STIR and early post-gadolinium T1 BB imaging are unremarkable. The extracellular volume fraction is 28%, which is within the normal range. These findings (T2, early gadolinium enhancement imaging, and ECV) suggest that there is no active diffuse inflammation. The interventricular septum myocardial T1 time is 1201ms (blood cavity 1729ms) which is significantly abnormally elevated, which suggests the presence of an underlying fibrosing or infiltrative process. There is an area of patchy late gadolinium enhancement in the basal to mid inferolateral wall. The pattern is atypical for myocardial infarction and also suggests the presence of an underlying fibrosing or infiltrative process. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant). 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 a small to moderate pericardial effusion located posteriorly.Extracardiac FindingsThere are mild bilateral pleural effusions with atelectasis or consolidation of both lungs. 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 mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%. 2. The interventricular septum myocardial T1 time is 1201ms which is abnormally elevated and there are areas of patchy late gadolinium enhancement in the basal to mid inferolateral wall in a pattern atypical for myocardial infarction. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Based on T2-weighted imaging, early gadolinium enhancement, and ECV fraction, there is no evidence of diffuse active inflammation. 3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%.4. There is a small to moderate pericardial effusion, posterior located.5. See extra cardiac findings above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.