19 year old male with sickle cell anemia with recent septic shock now resolving, referred for cardiac MRI after abnormal ECG and elevated troponins to evaluate for structural heart disease and anomalous coronary arteries. Left VentricleThe left ventricle is mild-moderately dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 85 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is mild late gadolinium enhancement in the mid septum which is quite focal and atypical for myocardial infarction. However, the images were of limited diagnostic quality due to respiratory motion.No iron overload of the myocardium. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 182 ml (normal range 142+/-31), the RV end systolic volume index is 56 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no obvious aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no obvious mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no obvious pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no obvious tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Coronary ArteriesThe right coronary artery arises normally from the right coronary cusp. The left main coronary artery arises normally from the left coronary cusps and bifurcates to give off the left anterior and left circumflex arteries. 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 small pericardial effusion present.Extracardiac FindingsThere is a nasogastric tube with associated metal artifact in the stomach. There is a moderate right pleural effusion. There is central venous catheter which terminates at the SVC-RA junction. Improving bilateral opacities consistent with resolving pulmonary edema.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. Mild-moderately dilated left ventricle with normal systolic function (EF 60%).2. Mild, very focal late gadolinium enhancement in the mid septal wall which is atypical for myocardial infarction. Significant motion artifact limits diagnostic certainty of this finding. Would suggest repeat imaging to better delineate this abnormality.3. The right ventricle is upper normal in size with normal systolic function( EF 51%).4. Normal origin of the coronary arteries. 5. Small pericardial effusion.6. Extracardiac findings as noted above. 