47 year old man with history of significant alcohol abuse and 2 months of worsening heart failure symptoms, found to have a severely reduced LV EF with no obstructive coronary disease. He was referred for cardiac MRI to evaluate for evidence of nonischemic cardiomyopathy etiologies. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 11%, the LV end diastolic volume index is 292 ml/m2 (normal range: 74+/-15), the LVEDV is 658 ml (normal range 142+/-34), the LV end systolic volume index is 260 ml/m2 (normal range 25+/-9), the LVESV is 586 ml (normal range 47+/-19), the LV mass index is 106 g/m2 (normal range 85+/-15), and the LV mass is 239 g (normal range 164+/-36). The wall motion is globally hypokinetic with regional variation, notably inferior wall akinesis, septal akinesis, mid-distal lateral wall akinesis, mid-distal anterior wall akinesis. No intracardiac thrombus was identified. There are two globular foci of late gadolinium enhacement in the basal and distal inferolateral wall; while these findings can be suggestive of a possible embolic phenomenon, these abnormalities are disproportionate to the associated wall motion. There is linear epicardial late gadolinium enhancement in the anteroseptum, mid anterior and anterolateral wall. The constellation of findings are highly suggestive of a component of post-viral myocarditis, perhaps superimposed on an underlying cardiomyopathy due to alcohol abuse.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 112 ml (normal range 54+/-17).Right AtriumThe right atrium is normal sized.Aortic ValveThe aortic valve is mildly thickened, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve demonstrates malcoaptation and there is mild associated 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 normal 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 trace pericardial effusion.Extracardiac FindingsTrace left pleural effusion. Wedge shaped focus favoring infarct in the superomedial spleen. Focal rounded area of high signal in the right lower lobe, which could represent possible nodule vs. artifact. If there is no previous outside chest CT imaging to compare, a dedicated low dose chest CT should be considered if clinically indicated.
1. Severely dilated left ventricle with severely reduced function (EF 11%). No intracardiac thrombus was identified. Patchy late gadolinium enhancement involving the epicardial antero septum, mid-distal anterior and anterolateral wall, and two additional globular foci in the basal and distal inferolateral wall. Taken together, these findings are highly suggestive of a component of post-viral myocarditis, perhaps superimposed on an underlying cardiomyopathy due to alcohol abuse. 2. Normal sized right ventricle with preserved systolic function.3. Wedge shaped infarct in the superomedial spleen.4. Focus of high signal in the posterior segment right lower lobe which could represent nodule versus artifact; further imaging with low dose CT thorax should be considered in absence of recent outside comparison CT for comparison. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.