A 59 years old male with HCV and past liver transplant, chronic kidney disease. Referred to MRI to evaluate suspected hypertrophic cardiomyopathy on echocardiography. Left VentricleThe left ventricle has hyperdynamic systolic function with normal size. A basal septum is 14mm thick and the posterior wall is 11mm thick. Although there is regional variation in the hypertrophy, strict criteria for hypertrophic cardiomyopathy are not met. Additionally, the regional function, as assessed by myocardial tagging, reveals preserved intramyocardial function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 54 ml/m2 (normal range: 74+/-15), the LVEDV is 123 ml (normal range 142+/-34), the LV end systolic volume index is 15 ml/m2 (normal range 25+/-9), the LVESV is 34 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). There are no regional wall motion abnormalities present.There is small amount of late gadolinium enhancement in the mid-myocardium only in the mid segment of the inferolateral wall. This finding is atypical for myocardial infarction and suggest the presence of a mild underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis. No evidence of iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle has hyperdynamic systolic function with normal size. The overall RV ejection fraction is 71%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 119 ml (normal range 142+/-31), the RV end systolic volume index is 15 ml/m2 (normal range 31+/-9), and the RVESV is 34 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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. There is a mild systolic anterior motion of the mitral leaflets and chordal structures causing mild flow acceleration in the left ventricular outflow tract.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 no obvious pericardial disease.Extracardiac Finding.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 has hyperdynamic systolic function with normal size, LVEF 72%. There are no regional wall motion abnormalities present. There is mild left ventricular hypertrophy with some degree of region variation; however, strict criteria for hypertrophic cardiomyopathy are not met.2. There is small amount of late gadolinium enhancement in the mid-myocardium only in the mid segment of the inferolateral wall. This finding is atypical for myocardial infarction and suggest the presence of a mild underlying fibrosing, infiltrative, or inflammatory process such as old myocarditis.3. The right ventricle has hyperdynamic systolic function with normal size, RVEF 71%. 4. There is mild systolic anterior motion of the mitral leaflets/ chordal apparatus associated with mild flow acceleration in the LVOT.