A 28 year old male with history of congenital HIV, s/p chemotherapy for lymphoma, EtOH abuse. Now hospitalized and found to have decreased left ventricular systolic function with an apical thrombus. Referred to cardiac MRI for further evaluation. MEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact was noted.Viability/ Myocardial ScarThere is a focal area of late gadolinium enhancement noted at the mid-to-apical segment of the infero-septal wall. This pattern is atypical for myocardial infarction and could represent fibrosis, inflammation, or infiltration. The rest of the myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 294 ml (normal range 142+/-34), the LV end systolic volume index is 120 ml/m2 (normal range 25+/-9), the LVESV is 252 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 107 g (normal range 164+/-36). There is severe global hypokinesis. Highly trabeculated myocardium noted extending form the apex to mid LV wall along the anterior, lateral and inferolateral walls. Maximum ratio of trabeculated to non-trabeculated myocardium in diastole on short-axis views (mid-myocardium level) is 21mm/6 mm = 3.5. The compacted myocardium is thin. This ratio is in keeping with a diagnosis of LV noncompaction.An apical thrombus was seen (22X11mm).Left AtriumThe left atrium is severely dilated (169ml). Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 19%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 254 ml (normal range 142+/-31), the RV end systolic volume index is 97 ml/m2 (normal range 31+/-9), and the RVESV is 205 ml (normal range 54+/-17). Right AtriumThe right atrium is severely dilated. Dilated coronary sinus.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate 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 (27 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumModerate-sized pericardial effusion. Extracardiac FindingsBilateral pleural effusions (right>left). Changes noted in the lung fields better described on dedicated lung imaging performed today (see report). 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 perfusion defects/ "ischemia" present during hyperemia.A dark rim artifact was noted.2. There is a focal area of late gadolinium enhancement noted in the mid-apical inferoseptum. This pattern is atypical for myocardial infarction and suggests underlying fibrosis, inflammation, or infiltration. The rest of the myocardium appears viable.3. the LV is severely dilated with severely reduced systolic function (LVEF 14%). Ratio of non-compacted to compacted myocardium measures 3.5. This is in keeping with a diagnosis of LV noncompaction.4. The RV is mildly dilated with severely reduced systolic function (RVEF 19%).5. Severe biatrial dilation.6. Severe mitral regurgitation.7. Mild to moderate tricuspid regurgitation.8. Moderate-size pericardial effusion. Suggest follow-up with echocardiogram.9. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.