56 year old man referred for evaluation of possible cardiac sarcoid. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. There is hypokinesis of the basal to mid anterior and anteroseptal walls. There is a mild diastolic septal bounce. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 118 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There are two small foci of late gadolinium enhancement in the apical septum that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 82 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 mild 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.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is significant thickening of the pericardium with evidence of increased T2-signal and pronounced late gadolinium enhancement of both the visceral and parietal pericardium. A trivial pericardial effusion is noted. There is evidence of myocardial to pericardial tethering mostly along the basal inferolateral wall. These findings are suggestive of active pericarditis.Extracardiac FindingsSubcarinal and hilar lymph nodes are noted. 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 mildly dilated with mildly reduced systolic function (LVEF 48%). There are two small (<5% of myocardial mass) foci of late gadolinium enhancement in the apical septum that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Assuming a diagnosis of extra-cardiac sarcoidosis is confirmed, these findings support the diagnosis of cardiac sarcoidosis. 2. Normal RV size and systolic function (RVEF 50%).3. There is significant thickening of the pericardium with evidence of increased T2-signal and pronounced late gadolinium enhancement. A trivial pericardial effusion is noted. There is evidence of myocardial to pericardial tethering mostly along the basal inferolateral wall. These findings are suggestive of active pericarditis.4. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.