26 year old woman with diagnosis of dermatomyositis, with tachycardia and chest pain in setting of troponin elevation. She was referred for cardiac MRI to evaluate for myocarditis. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 141 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 56 g/m2 (normal range 67+/-11), and the LV mass is 119 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a possible focus of mild epicardial late gadolinium enhancement in the mid anterolateral wall which is atypical for myocardial infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of focal myocardial edema.The native T1 myocardial relaxation time is abnormal at 1200ms. These values are moderately elevated, suggestive of underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 145 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). 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 normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial effusion or inflammation.Extracardiac FindingsBilateral lower lobe consolidation. There is an metallic artifact in the stomach likely related to a feeding tube. 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. Normal size left ventricle with hyperdynamic systolic function (EF 72%). While there is no focal myocardial edema, there is a possible focus of mild epicardial late gadolinium enhancement in the mid anterolateral wall which is atypical for myocardial infarction, and suggests an infiltrative, inflammatory or fibrotic process, including myocarditis. Additionally the native T1 myocardial relaxation time is moderately elevated (1200ms), which speaks to an underlying diffuse fibrotic or infiltrative process. 2. Normal size right ventricle with normal systolic function (EF 60%).3. Mild pulmonary artery dilation.4. Patchy areas of bilateral lower lobe consolidation which may represent pneumonia, aspiration, and/or organizing pneumonia.