A 74 year old male with history of hypertension, chronic kidney disease, coronary artery disease, s/p myocardial infarction and percutaneous coronary intervention to left circumflex and right coronary arteries, paroxysmal atrial fibrillation. Recently diagnosed with sarcoma in the left upper extremity. Due to intermittent low degree atrio-ventricular conduction defect (1st and Mobitz 2 degree AV block) was referred to cardiac MRI to rule out cardiac malignant involvement. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There is dyskinesis of the mid to apical inferior and infero-lateral walls. There is transmural late gadolinium enhancement and fatty replacement of the mid to apical inferior and infero-lateral walls . This findings is compatible with a transmural myocardial infarction and the affected segments are not viable. The remainder of the myocardium is viable and free of myocardial infarction or other forms of infiltration.No intracavitary thrombus was noted.No myocardial iron overload was noted.No malignant tumor was noted involving the heart.Left AtriumThe left atrium is normal in size (70ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 48 ml/m2 (normal range 82+/-16), the RVEDV is 119 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 59 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.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 upper limits of normal size (37 x 37mm).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.PericardiumSignificant pericardial fat was noted with no effusion and without evidence of hemodynamic influence.Extracardiac FindingsA large left lung mass and mediastinal lymph nodes are noted. 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 normal in size with low-normal systolic function, the LVEF is 53%. There is dyskinesis of the mid to apical inferior and inferolateral walls.2. There is transmural late gadolinium enhancement at the mid to apical inferior and inferolateral walls. This findings is compatible with a transmural myocardial infarction and these segments are not likely to be viable. 3. No malignant tumor was noted involving the heart.4. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. 5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.