83 year old female with history of breast cancer, diabetes and heart failure admitted with acute decompensated heart failure. CMR ordered to evaluate for etiology of left ventricular dysfunction, including infiltrative processes. Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 124 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 87 ml/m2 (normal range 18+/-5), the LVESV is 154 ml (normal range 31+/-10), the LV mass index is 82 g/m2 (normal range 67+/-11), and the LV mass is 146 g (normal range 114+/-24). The left ventricular systolic dysfunction is global. There is diffuse late gadolinium enhancement predominately in the bases in a pattern atypical for myocardial infarction to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The T1 times were elevated at 1250ms. There is no left ventricular thrombus. Left AtriumThe left atrium is moderately-severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 150 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is at least trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. Mild thickening anterior leaflet.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. PericardiumThere is a small circumferential pericardial effusion.Extracardiac FindingsBilateral small, left greater than right, pleural effusions with subsegmental atelectasis left lower lobe and lingula. Fluid noted in superior esophagus suggestive of reflux. Nonspecific T2 high signal focus in mid thoracic vertebral body, incompletely characterized. With the history of breast cancer, comparison to outside imaging recommended. In absence of such comparison, consider further cross sectional imaging.Evidence of previous left rotator cuff repair and deformity of left humeral neck, better visualized on radiograph 12/24/15.
1. The left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 30%. The left ventricular systolic dysfunction is global. 2. There is diffuse late gadolinium enhancement predominately in the bases in a mid and epicardial distribution atypical for myocardial infarction. Additionally, there is increased T1 times, in combination, these findings are consistent with infiltrative disease, such as myocardial amyloidosis.3. The right ventricle is normal in size and function. 4. Nonspecific T2 high signal focus in mid thoracic vertebral body. With the history of breast cancer, consider further cross sectional imaging (such as with spin echo MRI of spine).