66 year old man with history of hypertension, hyperlipidemia, and known aortic root dilation who presents for cardiac MRI as part of serial evaluation of aorta dimensions Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 100 ml (normal range 47+/-19). The LV mass index is 92g/m2, and the LV mass is 185g. There are no regional wall motion abnormalities present. There is a subtle area of epicardial late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 141 ml/m2 (normal range 82+/-16), the RVEDV is 286 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 146 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve leaflets are thickened but open widely. There is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root dimensions are as below:Sinus of Valsalva: 42mm x 42mm x 43 mm (9/2013: 43x 41x 42 mm)Sinotubular junction: 41x43 mm (9/2013: 41 x 40 mm)Ascending aorta at level of PA bifurcation: 49 x 50 mm (9/2013: 49 x48 mm)Proximal Arch: 40 x 43mmMid Arch: 33 x 25mm (9/2013: 34 x37 mm)Descending aorta: 32 x 29 mm (9/2013: 29 x31mm)Pulmonary VeinsAll pulmonary veins drain normally into the left atrium. There are three separate ostia of the right sided pulmonary veins.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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 mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, which is unchanged from the previous study.2. The right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 49%, which is improved from the previous study.3. There is subtle area of epicardial late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The pattern of late gadolinium enhancement likely represents some form of old myocarditis. Although not previously reported, on re-review of the last 2 studies it was present then as well.4. Dilated ascending aorta. Measurements as above. When compared to the 9/5/2013 study on a side-by-side basis with repeated measurements, the ascending aorta is minimally larger. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.