30 year old woman with cardiomyopathy referred to evaluated etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 190 ml/m2 (normal range: 65+/-11), the LVEDV is 398 ml (normal range 109+/-23), the LV end systolic volume index is 148 ml/m2 (normal range 18+/-5), the LVESV is 310 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 132 g (normal range 114+/-24). There is global hypokinesis. There is late gadolinium enhancement noted in the pattern of the septal mid-wall stripe. This pattern is associated with myocardial fibrosis and well described in dilated cardiomyopathy and old myocarditis. It does not consistent with old myocardial infarction. Based on T2-imaging there is no evidence of acute inflammation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 217 ml (normal range 110+/-24), the RV end systolic volume index is 86 ml/m2 (normal range 22+/-8), and the RVESV is 180 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 moderate to severe mitral regurgitation with bileaflet tethering.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 pericardial effusion.Extracardiac FindingsThere is atelectasis or infiltrate in the right lower lung. Small lymph nodes noted in bilateral axilla. 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. Severe LV dilation with severely reduced systolic function (LVEF 22%). On late gadolinium enhancement images, a mid-wall septal stripe is noted. This pattern is not consistent with myocardial infarction and suggests the presence of underlying myocardial fibrosis. The pattern has been commonly described in dilated cardiomyopathy and also in old myocarditis. There is no evidence of active inflammation based on T2-imaging. No evidence of myocardial iron overload. 2. Normal RV size with severely reduced systolic function (RVEF 17%). 3. Severe left atrial dilation.4. Moderate to severe mitral regurgitation with bileaflet tethering. 5. Small pericardial effusion.6. See extra-cardiac findings. 