A 80 year old male with personal history of hypertension, diastolic dysfunction, hyperlipidemia, stroke, diabetes, obstructive sleep apnea, chronic renal disease and morbid obesity. Recently diagnosed with MGUS. Echocardiography showed normal left and right ventricular function and left ventricular hypertrophy. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19). There is basal septum mild asymmetric hypertrophy (up to 13mm). There are no regional wall motion abnormalities present, the deformation images (tagging) are normal. The native T1 myocardial times are mildly increased, this is of unclear significance. The delayed enhancement images are suboptimal, but do not suggest significant delayed enhancement. The ECV is 24% in the basal septum.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (102ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 244 ml (normal range 142+/-31), the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).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 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. In the right PA just after the bifurcation, a signal defect was noted in multiple views concerning for thrombus.Venous AnatomyThe SVC and IVC and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate left pleural effusion. 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. The left ventricle is normal in size with normal systolic function, the LVEF is 63%. There is basal septum mild asymmetric hypertrophy (up to 13mm). Normal LV wall motion.2. The native T1 myocardial times are mildly increased, this is of unclear significance. The delayed enhancement images are suboptimal, but do not suggest significant delayed enhancement. The ECV is 24% in the basal septum.3. Mild left atrium dilation. 4. The right ventricle is normal in size and systolic function, the RVEF is 59%. 5. In the right PA just after the bifurcation, a signal defect was noted in multiple views concerning for thrombus. Dr A. Patel notified.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.