A 49 year old male with severe pulmonary arterial hypertension, systemic sarcoidosis with involvement of the lungs, skin, eyes, joints and probably of the heart. The patient is a candidate for lung transplant and is referred to cardiac MRI for further cardial assessment. Left VentricleThe left ventricle is small in size with moderate systolic dysfunction. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 122 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 43 g/m2 (normal range 85+/-15), and the LV mass is 91 g (normal range 164+/-36). The right ventricle is compressing the left ventricle, there is rightward shift of the interventricular septum ("D" shape) and the left ventricular filling is limited. There is late gadolinium enhancement with endocardial sparing involving the base and middle segments of the inferior wall as well as in the inferior hinge point of the interventricular septum. There is no intracavitary thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severe systolic dysfunction. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 162 ml/m2 (normal range 82+/-16), the RVEDV is 342 ml (normal range 142+/-31), the RV end systolic volume index is 120 ml/m2 (normal range 31+/-9), and the RVESV is 253 ml (normal range 54+/-17). There is hypertrophy.Right AtriumThe right atrium is severely 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 trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe 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 severely enlarged.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is mild mediastinal lymphadenopathy. There is mild atelectasis at the lung bases. No frank pulmonary fibrosis on pulmonary MRI. 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 small in size with moderate systolic dysfunction, the LVEF is 41%. The right ventricle is compressing the left ventricle, there is rightward shift of the interventricular septum ("D" shape) and the left ventricular filling is limited. 2. There is late gadolinium enhancement with endocardial sparing involving the base and middle segments of the inferior wall as well as the inferior hinge point of the interventricular septum. This pattern is atypical for myocardial infarction. The hinge point delayed hyperenhancement is highly suggestive of chronic RV pressure elevation likely representing chronic mechanical strain. However, the degree of delayed hyperenhancement involving the inferior wall of the LV is atypical of this phenomenon and certainly could represent cardiac sarcoidosis given history. Consider repeat MRI in 6 months to reevaluate this area.3. The right ventricle is severely dilated with severe systolic dysfunction, the RVEF is 26%. There is hypertrophy.4. The right atrium is severely dilated.5. There is severe tricuspid regurgitation.6. The main pulmonary artery is severely enlarged.