47 year-old male with new diagnosis of CHF with reduced EF. MRI to evaluate for myocarditis Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 275 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 194 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 127 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is subepicardial late gadolinium enhancement involving the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process and could be consistent with old myocarditis.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 136 ml/m2 (normal range 82+/-16), the RVEDV is 259 ml (normal range 142+/-31), the RV end systolic volume index is 91 ml/m2 (normal range 31+/-9), and the RVESV is 172 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild-moderate mitral regurgitation. This may be underestimated.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRound well-circumscribed mass noted in the spleen. Further characterization suggested using dedicated imaging. 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 severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 29%. There is global hypokinesis with regional variation. There is subepicardial late gadolinium enhancement involving the basal inferolateral wall which could be consistent with old myocarditis.2.The right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%3.At least mild-moderate mitral and tricuspid regurgitation4.Moderate biatrial enlargement