21 year old female with a history of clear cell carcinoma of the kidney with pulmonary metastatic lesions noted to have a large mediastinal mass and associated mass effect on the SVC and right atrium. She is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 109 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 22 g/m2 (normal range 67+/-11), and the LV mass is 38 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 95 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 35 ml (normal range 35+/-13). Right AtriumThere is a large right mediastinal mass measuring ~9.2 x 7.6 x 5.3 cm abutting the right atrium and super vena cava. The mass is causing extrinsic compression of the right atrium and superior vena cava. There is tethering of the inferior wall of the right atrium to the mass suggesting erosion of the mass into the right side of the heart however this is not very well characterized. 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 normal in size. Venous AnatomyThe SVC is compressed by the mediastinal mass as described above. IVC grossly normal in size and drains normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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 normal in size with normal systolic function (LVEF 55%). 2. The right ventricle is normal in size with normal systolic function (RVEF 63%). 3. There is a large right mediastinal mass measuring ~9.2 x 7.6 x 5.3 cm abutting the right atrium and super vena cava. There is a large right mediastinal mass measuring ~9.2 x 7.6 x 5.3 cm abutting the right atrium and super vena cava. The mass is causing extrinsic compression of the right atrium and superior vena cava. There is tethering of the inferior wall of the right atrium to the mass suggesting erosion of the mass into the right side of the heart however this is not very well characterized. 