17 year old man with dilated cardiomyopathy, referred for CMR for further evaluation of underlying etiology. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 136 ml/m2 (normal range: 74+/-15), the LVEDV is 223 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 101 g (normal range 164+/-36). LV dysfunction is global with regional variation. There is transmural late gadolinium enhancement involving the entire anterolateral wall, the basal to mid inferior wall, and the mid anterior wall. The pattern is atypical for prior myocardial infarction suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The lateral wall also has increased T2-signal suggesting the presence of myocardial inflammation. The global relative enhancement ratio is normal. Taken together, these findings support the diagnosis of myocarditis. 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 52%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 131 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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. The left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%. 2. There is evidence of a large amount of late gadolinium enhancement as described above associated with increased myocardial T2-signal. Taken together, these findings support the diagnosis of acute myocarditis. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.