69 year old woman with history of multiple myeloma, admitted with drug reaction and referred for evaluation of newly diagnosed heart failure.MEDICATIONS: lasix, prednisone First Pass PerfusionDuring hyperemia, no perfusion defects consistent with ischemia were present. However, fixed perfusion defect was noted in the basal inferoseptum and inferior walls and the mid inferolateral and anterolateral walls.Viability/ Myocardial ScarThere are two large areas of late gadolinium enhancement noted, one in the basal to mid anterior, anteroseptal and anterolateral walls and the second in the basal to mid inferolateral wall. They are both have an epicardial and mid myocardial pattern which is atypical for myocardial infarction and is suggestive of an underlying fibrosing, infiltrative, or inflammatory process. This pattern suggests the diagnosis of myocarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 67 ml (normal range 31+/-10), the LV mass index is 42 g/m2, and the LV mass is 71 g. There is hypokinesis of the mid inferolateral, anterolateral and anterior walls. 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 65%, the RV end diastolic volume index is 49 ml/m2 (normal range 69+/-14), the RVEDV is 83 ml (normal range 110+/-24), the RV end systolic volume index is 17 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). 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 and there is mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 drain normally into the right atrium. There is a catheter in the SVC.PericardiumThere is a small pericardial effusion.Extracardiac FindingsModerate bilateral pleural effusions are present. 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 "ischemia" is noted; however, the above fixed perfusion defects were noted, most likely related to the below described late gadolinium enhancement.2. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. There is hypokinesis of the mid inferolateral, anterolateral, and anterior walls. 3. There are two large areas of late gadolinium enhancement noted, one in the basal to mid anterior, anteroseptal and anterolateral walls and the second in the basal to mid inferolateral wall. They are both have an epicardial and mid myocardial pattern which is atypical for myocardial infarction and is mostly likely represents the diagnosis of myocarditis. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%.5. Small pericardial effusion is noted.6. See extra cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.