46 year old man admitted with chest pain and troponin elevation, found to have no significant coronary artery disease, referred for further evaluation of possible myocarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 125 g (normal range 164+/-36). There is regional thickening of the basal inferolateral and mid lateral walls (12mm). There are no regional wall motion abnormalities present. There is increased signal intensity on T2 STIR imaging in the basal inferolateral and lateral walls that is indicative of myocardial edema. T1 BB imaging shows evidence of early gadolinium enhancement in the basal lateral wall, which is indicative of an inflammatory process. There is a large area of patchy, transmural late gadolinium enhancement in the basal to mid inferolateral and lateral walls. This pattern is not well demarcated, which is atypical for myocardial infarction, however the possibility of a left circumflex infarct cannot be excluded. Overall, the findings of increased myocardial edema, early gadolinium enhancement (inflammation) and late gadolinium enhancement in the basal to mid inferolateral and lateral walls is highly suggestive of inflammatory stage of myocarditis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 144 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 67 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 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 "psuedo-bovine" brachiocephalic branching pattern (normal variant). 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 no obvious pericardial disease.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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%. 2. There is evidence of myocardial thickening, edema, early gadolinium enhancement and late gadolinium enhancement in the basal to mid inferolateral and lateral walls. These findings are highly suggestive of inflammatory stage of myocarditis, although the possibility of an acute left circumflex infarction cannot be excluded.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%.