75 year old male with a history of coronary artery disease, status post CABG. Referred for cardiovascular MRI due to recent development of frequent non-sustained ventricular tachycardia. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is apical thinning with corresponding hypokinesis. There is also asymmetric basal and mid-septal hypertrophy, with a maximum thickness of 1.8 cm. There is no evidence of accelerated flow in the subvalvular outflow tract. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 69 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There is extensive abnormal enhancement throughout the left ventricular myocardium, patchy in character within the hypertrophied segments. It is sub-endocardial and mid-mycoardial in mid inferior and inferoseptal walls, basal inferior and inferoseptal walls. This pattern is suggestive of hypertrophic cardiomyopathy.At the apical 1/4 of the lateral wall, there is additional high signal, linear in character and transmural, which may represent an infarct. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 127 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).No abnormal enhancement of the RV free wall.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. There is mild chordal SAM. No anterior motion of the anterior leaflet of the mitral valve is present. A small regurgitant jet is consistent with mitral regurgitation, not quantified, but visually appears trace. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with anomalous right subclavian artery. 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.PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires are noted. Exophytic cystic lesion left hepatic lobe stable in size since 2006, at which time was characterized as a hemangioma. Stable left lateral outpouching at distal esophagus suggestive of diverticulum or hiatal hernia.
1. Left ventricular cavity is normal in size with mildly reduced systolic function (LVEF 53%). Asymmetric basal and mid-septal hypertrophy measuring up to 18mm. Extensive enhancement which is patchy and atypical for infarct. Mild chordal SAM. No anterior motion of the anterior leaflet of the mitral valve is present. A small regurgitant jet is consistent with mitral regurgitation, not quantified, but visually appears trace. The constellation of findings is suggestive of hypertrophic cardiomyopathy.Additional transmural gadolinium enhancement at the lateral apex, which is akinetic, raises a question of infarct. This may contribute to the low EF, not the typical hyperdynamic state for HCM. 2. Normal right ventricular size and systolic function (RVEF 60%). No RV enhancement.3. Aberrant right subclavian artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.