71 year old male with history of recent pericardial effusion diagnosis by echocardiography without associated symptoms, referred for cardiac MRI for additional evaluation. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 74%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 17 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19). There is hypokinesis of the most apical segments. There is eccentric hypertrophy in a pattern of apical hypertrophy. The hypertrophy also extends to the mid lateral wall, but is clearly not concentric, with maximal wall thickness of 18mm in the mid to apical lateral wall. There is patchy late gadolinium enhancement im multiple myocardial segments. The apex and distal-mid lateral are most heavily involved, but there is also mild enhancement of the the mid anterior and inferior wall. It is not subendocardial and is not consistent with previous myocardial infarction. This pattern would suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The gadolinium pattern in the hypertrophied areas likely represents scarring, but the involvement outside the most hypertrophied segments suggests either a more mild hypertrophic process in these segments, or a super imposed infiltrative disorder. The native T1 myocardial relaxation time is elevated between 1100-1200ms. There is no myocardial iron overload. There is [no]LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 146 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is chordal SAM noted with 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 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.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a moderate-large circumferential pericardial effusion which predominantly posterior, overlying the left atrium and ventricle. There is no evidence of abnormal septal motion with respiratory variation, nor is there evidence for right atrial or right ventricular collapse. The maximal width of the effusion is 2.5cm posteriorly.Extracardiac FindingsThis 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. There is eccentric hypertrophy in a pattern of apical hypertrophy. The hypertrophy also extends to the mid lateral wall, but is clearly not concentric, with maximal wall thickness of 18mm in the mid to apical lateral wall. There is patchy late gadolinium enhancement im multiple myocardial segments. The apex and distal-mid lateral are most heavily involved, but there is also mild enhancement of the the mid anterior and inferior wall. It is not subendocardial and is not consistent with previous myocardial infarction. This pattern would suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The gadolinium pattern in the hypertrophied areas likely represents scarring, but the involvement outside the most hypertrophied segments suggests either a more mild hypertrophic process in these segments, or a super imposed infiltrative disorder.2. Chordal SAM is noted with at least mild regurgitation. 3. Normal size RV with normal systolic function (EF 52%).4. Marked biatrial enlargement.5. Large pericardial effusion which is circumferential, but predominantly posterior overlying the left ventricle (maximal depth of 2.5cm). There is no definitive associated pericardial inflammation. There is no evidence for overt hemodynamic compromise due to the effusion.