20 year old woman with exertional pre-syncope referred for further evaluation of underling cardiac structure and fibrosis. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 194 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 81 g/m2 (normal range 67+/-11), and the LV mass is 152 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a subtle, small amount of epicardial late gadolinium enhancement involving the basal inferoseptum and inferior wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. In the same region, there is decreased post-contrast T1 times confirming the finding using a different pulse sequence. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 84 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is tri-leaflet, 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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Normal origin of the coronary arteries. 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 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 63%. There is a subtle, small amount of epicardial late gadolinium enhancement involving the basal inferoseptum and inferior wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 59%.3. Although the mechanism of late gadolinium enhancement is not evident, mild biventricular dilation and late gadolinium enhancement has previously been described in marathon runners. The differential diagnosis also includes but is not limited to prior myocarditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.