64 year old male with high degree heart block and episodes of VT, concern for infiltrative disease Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 51%. The LVEDV is 247 ml (normal range 142+/-34), the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVESV is 122 ml (normal range 47+/-19) and the LV end systolic volume index is 57 ml/m2 (normal range 25+/-9). The LV mass is 245 g (normal range 164+/-36) and the LV mass index is 114 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. T2 STIR images suggest the presence of diffuse edema/inflammation at the base of the heart. There is presence of late gadolinium enhancement in the mid to basal inferior and inferolateral myocardial wall, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is an area in the basal septum that could represent late gadolinium enhancement however this finding could also represent partial volume artifact due to LV outflow tract. Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with normal function. The overall RV ejection fraction is 57%. The RVEDV is 212 ml (normal range 142+/-31), RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVESV is 91 ml (normal range 54+/-17), and the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 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 39mm 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 a small pericardial effusion. There is also evidence of patchy edema/inflammation of the pericardium at the level of the mid-inferolateral and apical lateral wall on T2 STIR images. There is mild thickening of the pericardium. Extracardiac FindingsThere is evidence of mediastinal adenopathy present. There is also presence of axillary adenopathy. Possible pleural thickening 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. Left ventricle is normal in size with mildly reduced LV ejection fraction at 51%. There are no wall motion abnormalities. 2. Right ventricle is normal in size with normal RV ejection fraction at 57%3. T2 STIR images suggest the presence of diffuse edema/inflammation at the base of the heart. This is consistent with an inflammatory process in the myocardium. 4. There is late gadolinium enhancement extending from the mid to basal inferior and inferolateral myocardial walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is an area in the basal septum that could represent late gadolinium enhancement however this finding could also be due to LV outflow tract partial volume artifact. 5. There is a small pericardial effusion with evidence of patchy edema/inflammation in the mid-inferolateral and apical lateral wall on T2 STIR images. 6. Mild thickening of the pericardium. 7. This constellation of findings is suggestive of cardiac sarcoid given the clinical context with acute pericarditis and evidence of myocarditis. Other causes of myocarditis and pericarditis should be included in the differential.8. See extracardiac findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.