A 49 year old male with personal history of viral pericarditis on 2010 with tamponade that required pericardiocentesis and drainage. Recently an echocardiography was performed due to dyspnea and showed a left ventricular ejection fraction of 31%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal size with mildly reduced systolic function. There is a significant diastolic bounce of the interventricular septum. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 102 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 98 g (normal range 164+/-36). There is epicardial late gadolinium enhancement involving the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is not typical for prior myocardial infarction.Left AtriumThe left atrium is normal in size (87ml). Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 163 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 82 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 mild mitral regurgitation.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 mild thickening of the pericardium with evidence of pericardial late gadolinium enhancement but not increased T2-signal. Additionally there is significant respiratory variation in the position of the interventricular septum. These findings suggest the diagnosis of constrictive pericarditis in the fibrotic stage.Extracardiac FindingsThe esophagus is dilated with significant thickening of the esophageal wall. Mediastinal lymphadenopathy is 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. Normal LV size with mildly reduced systolic function (LVEF 47%) with epicardial late gadolinium enhancement in the basal inferolateral wall, consistent with the patients history of known prior myocarditis.2. There is mild thickening of the pericardium with evidence of pericardial late gadolinium enhancement without increased T2-signal. Additionally there is a prominent diastolic bounce of the interventricular septum which is associated with significant respiratory variation in the septal position. These findings suggest the diagnosis of constrictive pericarditis in the fibrotic stage.3. Normal RV size and systolic function (RVEF 50%).4. The esophagus is dilated with significant thickening of the esophageal wall. Mediastinal lymphadenopathy is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.