54 year old man with history of SLE, non-ischemic cardiomyopathy, referred for evaluation of possible lupus related myocarditis. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 236 ml/m2 (normal range: 74+/-15), the LVEDV is 471 ml (normal range 142+/-34), the LV end systolic volume index is 199 ml/m2 (normal range 25+/-9), the LVESV is 397 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 114 g (normal range 164+/-36). LV dysfunction is global. There is a small patch of subendocardial late gadolinium enhancement in the basal-mid inferior wall. This pattern may be due to a small RCA branch infarct (given history of non-ischemic cardiomyopathy possibly embolic vs native atherosclerosis) or a prior fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is viable. There are no findings indicative of an acute myocarditis (increased myocardial edema or acute inflammation).Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 22%, the RV end diastolic volume index is 160 ml/m2 (normal range 82+/-16), the RVEDV is 320 ml (normal range 142+/-31), the RV end systolic volume index is 125 ml/m2 (normal range 31+/-9), and the RVESV is 249 ml (normal range 54+/-17).Right AtriumThe right atrium size is difficult to determine due to defibrillator artifact, however it appears moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is apically displaced due to bi-leaflet tethering. There is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root size is unable to be measured due to defibrillator artifact. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery size is unable to be measured due to defibrillator artifact.Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are moderate bilateral pleural effusions (R>L). Right chest ICD with defibrillator wire in the RV noted with associated artifact. Probable renal cysts. Calcified splenic granulomas likely explains focal areas of hypointensity within the splenic tissue. 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. No evidence of acute myocarditis.2. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%. LV dysfunction is global.3. There is a small patch of subendocardial late gadolinium enhancement in the basal-mid inferior wall. This pattern may be due to a small RCA branch infarct (given history of non-ischemic cardiomyopathy possibly embolic vs native atherosclerosis); less likely a prior fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is viable.4. The right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 22%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.