66 year old female with non-ischemic cardiomyopathy status-post cardiac transplant with DeVega tricuspid valve repair in 2015 admitted for shortness of breath, referred for cardiac MRI to evaluate for pericarditis or rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 39 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Gadolinium was not administered due to the patient's renal status. The native pre-contrast T1 myocardial relaxation time ranges 1000-1080 ms (normal). T2-stir mapping sequence suggests inflammation of majority of the pericardium. The apical septal and apical anterior myocardium appear have a hyperintense signal on T2-stir mapping suggestive of edema or inflammation. This area is accessible to endomyocardial biopsy. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate 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.PericardiumThe pericardium is circumferentially thickened with a maximal diameter of 6 mm.Extracardiac FindingsThere are sternotomy wires present. There are bilateral pleural effusions, left greater than right. 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 and systolic function (LVEF 55%).2. The right ventricle is normal in size and systolic function (RVEF 55%).3. The pericardium is circumferentially thickened with a maximal diameter of 6 mm. T2-stir mapping sequence suggests inflammation of majority of the pericardium. The apical septal and apical anterior myocardium appear have a hyperintense signal on T2-stir mapping suggestive of edema or inflammation. This area is accessible to endomyocardial biopsy. 4. The native pre-contrast T1 myocardial relaxation time of the septum ranges 1000-1080 ms (normal). 5. There are bilateral pleural effusions, left greater than right.6. Overall the constellation of findings are consistent with pericarditis with possible associated myocardial edema/inflammation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.