A 54 year old female with hypertension and hyperlipidemia who suffered a syncope and shocked for wide complex tachycardia, now with portable defibrillator. The echocardiography showed normal findings beside mild left atrial enlargement. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 190 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 49 g/m2 (normal range 67+/-11), and the LV mass is 105 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is abnormal gadolinium enhancement, which is intermediate signal, involving the basal 1/3 of the anterior and anterolateral walls of the left ventricle. It is transmural at the anterior wall and involves a portion of the mid myocardium at the basal anterolateral wall. The appearance is atypical for infarct. There is no intracardiac thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 178 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 73 ml (normal range 35+/-13). No abnormal enhancement is present.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 tricuspid regurgitation which appears trace; dedicated imaging was not performed.AortaThere is a left sided aortic arch. There is a common origin of the innominate and left common carotid arteries.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.ExtracardiacThere are multiple T2 high signal lesions favoring cysts or hemangiomas, some of which are partially calcified when compared to previous CT.
1. The left ventricle is mildly dilated with normal systolic function (LVEF 57%). There is intermediate signal abnormal enhancement involving the anterior and anterolateral walls of the left ventricle. Considerations include an infiltrative disease such as sarcoidosis or prior inflammatory process from previous myocarditis.3. The right ventricle is normal in size and systolic function (RVEF 58%).  