28 year old woman with no medical history who presents with new onset of heart failure symptoms and was found to have significant left ventricular hypertrophy on echo suggestive of possible hypertrophic cardiomyopathy. She was referred for cardiac MRI to evaluate for possible HCM. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. There is severe hypertrophy with regional variation. The interventricular septum is thickest with a wall thickness of 20mm. The anterolateral wall is ~9mm thick. The overall LV ejection fraction is 74%; however, based on myocardial tagging intramyocardial motion is significantly reduced. The LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 141ml (normal range 109+/-23), the LV end systolic volume index is 17ml/m2 (normal range 18+/-5), the LVESV is 36ml (normal range 31+/-10), the LV mass index is moderately increased, measuring 107g/m2 (normal range 67+/-11), and the LV mass is 233g (normal range 114+/-24). No evidence of myocardial iron deposition. There is patchy late gadolinium enhancement in the septum consistent with macroscopic myocardial fibrosis. The overall burden of fibrosis is mild. The native myocardial T1 time ranges between 1150-1250ms suggest that there is a significant amount of microscopic fibrosis. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 51ml/m2 (normal range 69+/-14), the RVEDV is 112ml (normal range 110+/-24), the RV end systolic volume index is 18ml/m2 (normal range 22+/-8), and the RVESV is 39ml (normal range 35+/-13). 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 mild systolic anterior motion of the mitral valve with mild regurgitation and mild flow acceleration in the left ventricular outflow tract. 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 bovine 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 a small pericardial effusion.Extracardiac FindingsThere is a 11mm lymph node in the left axilla. 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. Severe, asymmetric hypertrophy of the left ventricle with normal systolic function (EF = 74%) . The interventricular septum is most prominently hypertrophied with a maximum wall thickness of 20mm. There is a small burden of macroscopic fibrosis/ late gadolinium enhancement noted in the septum. Based on native myocardial T1-mapping, the patient likely has a significant amount of microscopic myocardial fibrosis. These findings are consistent with the diagnosis of hypertrophic cardiomyopathy. 2. Normal size RV with normal systolic function (EF = 65%). 3. Systolic anterior motion of the mitral valve with mild mitral regurgitation and mild flow acceleration in the LVOT. 4. Moderate left atrium dilatation. 5. There is a 11mm lymph node in the left axilla.Findings were reviewed with cardiology consult team. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.