66 year old male with history of head and neck cancer, found to have severe left ventricular hypertrophy on ECHO. Cardiac MRI done to evaluate for hypertrophic cardiomyopathy and/or infiltrative disease. Left VentricleThe left ventricle is normal in size and systolic function. The anteroseptal wall measures 12 mm and the posterior wall is 10 mm in thickness (i.e. mild left ventricular hypertrophy). A prominent sigmoid septum is noted (normal variant). The overall LV ejection fraction is 61%, the LV end diastolic volume index is 56 ml/m2 (normal range: 74+/-15), the LVEDV is 107 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 97 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. 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 61%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 106 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 trivial mitral regurgitation. The anterior mitral valve leaflet is thickened and somewhat calcified. There is no systolic anterior motion.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 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 and systolic function (61%)2. The right ventricle is normal in size and systolic function (61%)3. Mild left ventricular hypertrophy with no evidence of outflow tract obstruction. A prominent sigmoid septum (which is a normal variant) is present. The echo measurement is overestimating the severity of left ventricular hypertrophy due to inability to distinguish the endocardial border from adjacent trabeculae, papillary muscles, and RV myocardium. 4. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. 