A 59 years old male with non-ischemic cardiomyopathy, severe systolic dysfunction, diabetes mellitus, hypertension, colon cancer with chemotherapy. Diagnosed on 12/2014 with a right atrial clot associated to a catheter that was removed and then the clot was not seen in the following echocardiography. Now referred to MRI for further evaluation including etiology of the myocardial dysfunction. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 377 ml (normal range 142+/-34), the LV end systolic volume index is 108 ml/m2 (normal range 25+/-9), the LVESV is 276 ml (normal range 47+/-19), the LV mass index is 97 g/m2 (normal range 85+/-15), and the LV mass is 249 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is a mid-wall stripe late gadolinium enhancement in the interventricular septum which is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing process. The pattern is most commonly described in patients with dilated cardiomyopathy. Right VentricleThe right ventricle is severely dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 322 ml (normal range 142+/-31), the RV end systolic volume index is 87 ml/m2 (normal range 31+/-9), and the RVESV is 223 ml (normal range 54+/-17).AtriumThe left atrium is severely dilated. The right atrium is moderately dilated.No interatrial shunt was noted. There is a mass in the right atrial appendage, which is not particularly mobile and most likely represent residual calcified thrombus, based on the patients clinical history and MRI findings. Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. There is a diastolic mitral regurgitation noted.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 ascending aorta is mildly dilated (46mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated in size (41mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsMild bilateral pleural effusion was noted. 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. The left ventricle is severely dilated with severe systolic dysfunction, LVEF 27%. There is a mid-wall stripe of late gadolinium enhancement involvement the interventricular septum. The finding is atypical for prior myocardial infarction and suggests the presence of underlying fibrosis as might be seen in dilated cardiomyopathy.2. The right ventricle is severely dilated with moderate to severe systolic dysfunction, RVEF 31%.3. There is a mass in the right atrial appendage, which is not particularly mobile and most likely represent residual calcified thrombus, based on the patients clinical history and MRI findings. 4. The left atrium is severely dilated. The right atrium is moderately dilated. No interatrial shunt was noted. 5. There is mild to moderate aortic regurgitation.6. There is mild mitral regurgitation.7. The ascending aorta is mildly dilated8. The main pulmonary artery is severely dilated in size (41mm).9. Mild bilateral pleural effusion was noted. 