A 55 year old male with history of hypertension and a past hospitalization in Ghana due to cardiac reasons (no other details known). Now hospitalized because of a clinical picture of non-ST elevation myocardial infarction, the cardiac catheterization showed extensive coronary artery disease. Now referred to cardiac MRI to evaluate function, viability and suspected apical thrombus. Left VentricleThe left ventricle is normal in size with severe systolic dysfunction. There is asymmetric hypertrophy of the interventricular septum which suggests the diagnosis of underlying hypertrophic cardiomyopathy (septum 17mm, posterior wall 11mm). No systolic anterior movement of the mitral leaflet or LVOT flow acceleration was noted. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9), the LVESV is 159 ml (normal range 47+/-19), the LV mass index is 90 g/m2 (normal range 85+/-15), and the LV mass is 198 g (normal range 164+/-36). There are 2 distinct wall motion abnormalities noted. The first is smaller and involves the basal inferior hypokinesis. This segment is associated with a slight increase in T2-signal, has preserved wall thickness, and a transmural myocardial infarction (i.e. late gadolinium enhancement) Suggesting this might be secondary to the patient's recent non-ST elevation myocardial infarction. This segment has indeterminate viability. The second wall motion abnormality is much larger (mid anterior wall and apical anterior, septum, and inferior walls) and is associated with thinned myocardium and a large transmural myocardial infarction (i.e. late gadolinium enhancement). These segments are not likely to be viable. There is no other late gadolinium enhancement present and the remainder of the myocardium is viable. A large apical thrombus is present. No iron overload was noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 71 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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (ascending aorta 40mm).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 severe systolic dysfunction, LVEF is 30%. There is asymmetric hypertrophy of the interventricular septum suggesting the diagnosis of hypertrophic cardiomyopathy. Additionally, there are 2 distinct myocardial infarctions as described below.2. There is extensive transmural late gadolinium enhancement involving most of the apex and the mid anterior wall. This late gadolinium enhancement is associated with myocardial thinning and is due to an older myocardial infarction. This territory is not viable. 3. There is a second small transmural myocardial infarction involving the basal inferior wall. The myocardial infarction is within myocardium of preserved wall thickness and has evidence of increased T2-signal suggesting that it occurred more recently. The viability in this territory is indeterminate at this stage.4. No other myocardial infarctions are noted and the remainder of the myocardium is viable. 5. A large LV apical thrombus is present. 6. The right ventricle is normal in size and systolic function, RVEF is 50%. 