44 year old with history of DLBCL and history of acute pericarditis presenting for evaluation of chest pain and evaluation for chronic pericarditis and/or constrictive physiology. MEDICATIONS: colchicine, prednisone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), the LVEDV is 98 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 45 g/m2, and the LV mass is 74 g. There are no regional wall motion abnormalities present. The native T1 times are mildly to moderately elevated at approximately 1150 ms, possibly due to interstitial fibrosis. Left AtriumThe left atrium is grossly normal in size. 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 66 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is grossly 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 mild circumferential pericardial thickening with evidence of increased signal on T2-weighted imaging, early gadolinium enhancement, and late gadolinium enhancement. All of these findings are consistent with the diagnosis of inflammatory pericarditis. There is no obvious change in septal motion during respiration; nor is there evidence of pericardial to myocardial tethering noted on myocardial tagging images suggesting the absence of constriction. Extracardiac FindingsThis 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%).4. Normal RV size and systolic function (RVEF 55%).5. There is mild circumferential pericardial thickening with evidence of increased signal on T2-weighted imaging, early gadolinium enhancement, and late gadolinium enhancement. All of these findings are consistent with the diagnosis of inflammatory pericarditis. There is no obvious evidence of pericardial constriction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.