45 year-old female with shortness of breath and previous MRI suggestive of constriction. For follow-up study. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 52 ml/m2 (normal range: 65+/-11), the LVEDV is 98 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10). There is systolic and diastolic flattening of the septum. Free-breathing sequences suggestive respirophasic shift of the septum. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mild systolic dysfunction. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 175 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate 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 moderately dilated (35 mm). Venous AnatomyThe IVC is dilated. PericardiumSevere calcification of the pericardium. Pericardium thickness measured to be ~ 4-6 mm. Tagged images show that there is tethering of the pericardium to the myocardium at the basal lateral wall of the LV suggesting evidence of constriction. Extracardiac FindingsMediastinal adenopathy. Bilateral pleural effusions. 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 ventricular size and systolic function are normal. LVEF is 65%.2. The right ventricular size is normal with mildly reduced systolic function. RVEF is 44 %.3. Thickening of the pericardium with extensive calcification of the pericardium at the base of the ventricles with evidence of respirophasic septal shift. In addition, the base of the ventricle is tethered to the pericardium. There is additionally significant IVC and biatrial dilation. These constellation of findings are strongly suggestive of the diagnosis of pericardial constriction.4. Findings in keeping with previous MRI done in 2014. 