55 year old male with recently diagnosed renal amyloid. He 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 68%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 179 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is normal gadolinium kinetics. There is patchy late gadolinium enhancement in the basal interior, inferolateral, and lateral walls in addition to the mid lateral wall. This pattern of late gadolinium enhancement is atypical for myocardial infarction and could be suggestive of an underlying fibrosing, infiltrative, or inflammatory process including amyloid. Myocardial native T1 time is elevated at 1178 ms which could be consistent with underlying diffuse fibrosis.Left AtriumThe left atrium is mildly dilated. There is an aneurysmal inter-atrial septumRight VentricleThe right ventricle is normal in size with normal systolic function The overall RV ejection fraction is 60%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 77 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 mildly dilated (37 mm) in size.Venous AnatomyThe SVC and IVC drain 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. The overall LV ejection fraction is 68%. There are no regional wall motion abnormalities present. 2. There is patchy late gadolinium enhancement in the basal interior, inferolateral, and lateral walls in addition to the mid lateral wall. This pattern of late gadolinium enhancement is atypical for myocardial infarction and could be suggestive of an underlying fibrosing, infiltrative, or inflammatory process including amyloid. Myocardial native T1 time is elevated at 1178 ms which could be consistent with underlying diffuse fibrosis.3. The right ventricle is normal in size with normal systolic function The overall RV ejection fraction is 60%.4. Bilateral atrial enlargement. There is an aneurysmal inter-atrial septum5. The constellation of findings taken together are highly suggestive of cardiac amyloid.