66 year old woman with recent hemorrhagic pericardial effusion referred to evaluate for constriction and myocarditis. Left VentricleThe left ventricle is normal LV size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 62 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 59 ml (normal range 31+/-10), the LV mass index is 54 g/m2 (normal range 67+/-11), and the LV mass is 120 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 77 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). 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 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, heterogenous appearing, loculated pericardial effusion along the posterior wall. There is mild, circumferential thickening of the pericardium with evidence of increased T2 signal and early gadolinium enhancement, suggesting the presence of active inflammation. There is additionally late gadolinium enhancement of the visceral and parietal pericardium, which can represent both inflammation or fibrosis. Based on myocardial tagging, there is tethering of the pericardium to the posterior wall of the myocardium. There is no respiratory variation in the interventricular septal position suggesting that the pericardial changes are not causing constriction at the current LV volume load. Extracardiac FindingsModerate bilateral pleural effusions. 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. There is a small, heterogenous appearing, loculated pericardial effusion along the posterior wall. There is mild, circumferential thickening of the pericardium with evidence of acute inflammation; however, there is no respiratory variation in the interventricular septal position suggesting that the pericardial changes are not yet causing constriction at the current LV volume load. 2. Normal left ventricular size and systolic function (LVEF 57%) without evidence of underlying myocardial fibrosis, infiltration, or inflammation. 3. Normal right ventricular size with mildly reduced systolic function (RVEF 49%).4. Moderate bilateral pleural effusions.