38 year old with history of systemic lupus erythmatosus presenting with worsening left ventricular dysfunction, chest pain and TTP. Left VentricleThe left ventricle is severely enlarged with mild to moderately reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 137 ml/m2 (normal range: 65+/-11), the LVEDV is 286 ml (normal range 109+/-23), the LV end systolic volume index is 96 ml/m2 (normal range 18+/-5), the LVESV is 200 ml (normal range 31+/-10), the LV mass index is 60 g/m2 (normal range 67+/-11), and the LV mass is 123 g (normal range 114+/-24). The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 105 ml/m2 (normal range 69+/-14), the RVEDV is 220 ml (normal range 110+/-24), the RV end systolic volume index is 62 ml/m2 (normal range 22+/-8), and the RVESV is 130 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered and there is at least 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern with a common origin of the left brachiocephalic and left common carotid. 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. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a catheter in terminating at the SVC/RA junction. PericardiumThere is a small pericardial effusion. Thickening of the pericardium (5-6 mm) consistent with thickening inflammation and acute pericarditis.Extracardiac FindingsThere is a body piercing on bilateral breasts. 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 severely enlarged with mild to moderately reduced systolic function. The overall LV ejection fraction is 30%. The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process (no evidence of myocarditis)2. The right ventricle is mildly dilated with mildly reduced systolic function (RVEF 41%)3. Thickening and inflammation of the pericardium consistent with pericarditis. Small circumferential pericardial effusion with no evidence of hemodynamic compromise. 4. Significant left atrial enlargement I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.