82 year old with history of hypothyroidism, T2DM, ?amyloid (hyperglobulinemia) who presents from OSH for workup heart failure. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. There is LV hypertrophy (14-17 mm). The overall LV ejection fraction is 36%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19). The left ventricular dysfunction is global. The late gadolinium enhancement images reveal diffuse transmural Gd enhancement. This is a finding that is typical for amyloidosis. Additional supportive findings include: Inability to completely null the myocardium on LL series. Elevated native T1 times at 1174 ms (normal < 1050 ms). MArked delayed enhancement of the atrial wall. Delayed enhancement in the RV wall.Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function . There is right ventricular hypertrophy. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.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 aortic root is normal in size.Pulmonary Veins3 pulmonary veins drain normally into the left atrium (LUPV not well seen)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.Extracardiac FindingsBilateral interstitial markings at lung bases. 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 normal in size with moderately reduced systolic function and severe LVH (LVEF 36%) The left ventricular dysfunction is global. The late gadolinium enhancement images reveal diffuse transmural Gd enhancement. This is a finding that is typical for amyloidosis. Additional supportive findings include: Inability to completely null the myocardium on LL series. Elevated native T1 times at 1174 ms (normal < 1050 ms). MArked delayed enhancement of the atrial wall. Delayed enhancement in the RV wall.2. The right ventricle is normal in size with moderately reduced systolic function . There is right ventricular hypertrophy. The overall RV ejection fraction is 31%. 3. There is a small pericardial effusion