63 year-old man status-post lung transplant on immunosuppression with an echocardiogram suspicious for constriction. MRI ordered to further evaluate. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 77 g/m2 (normal range 85+/-15), and the LV mass is 179 g (normal range 164+/-36). There are no regional wall motion abnormalities present. No hyperenhancement noted in the myocardium on T2 stir images. Native myocardial T1 is mildly abnormal at 1055 msec. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 182 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17). There is external compression of the RV. Right AtriumThe right atrium is normal in size. Thickening along the right atrial wall.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 dilated (43 mm) in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThickening of the pericardial sac (9 mm inferiorly in the coronal plane and up to 11 mm anteriorly in the axial plane) . There is a loculated chronic fluid collection which appears to be in the pericardial space, adjacent to the free-wall of right ventricle with prominent septations. Respirophasic septal shift noted on free-breathing sequences with evidence of tethering of the myocardium to the pericardium on tagged sequences. These findings are strongly suggestive of constriction. A collection of fat is also noted along the right ventricular free-wallExtracardiac FindingsInterstitial pattern and likely post-operative changes noted in the lungs. Dedicated chest CT would help to better assess these changes. 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 with normal systolic function. The overall LV ejection fraction is 60%2. The right ventricle is normal in size with normal systolic function. There is external compression of the RV.3. There is thickening of the pericardial sac. A loculated fluid collection which appears chronic is noted in the pericardial space. This collection sits alongside the free-wall of the right ventricle in the axial plane and contains prominent septation. A band of fat is also noted along-side the RV free-wall adjacent to this fluid collection. Respirophasic septal shift noted on free-breathing sequences with evidence of tethering of the myocardium to the pericardium on tagged sequences. 4. Due to the patient's low GFR contrast was not administered. 5. These findings are strongly suggestive of constriction. 