56 year old female with history of previous cardiomyopathy (EF of 17% at nadir, improved to 40% by report), and a recent diagnosis of pulmonary sarcoidosis after presenting with hemoptysis requiring a right upper lobe wedge resection of her lung. She was referred for cardiac MRI to evaluate for cardiac sarcoid. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 109 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 72 ml/m2 (normal range 18+/-5), the LVESV is 143 ml (normal range 31+/-10), the LV mass index is 48 g/m2 (normal range 67+/-11), and the LV mass is 95 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a patch of late gadolinium enhancement involving the basal inferior wall but sparing the endocardium. The burden of late gadolinium enhancement involves approximately 5% of the myocardium. This region is additionally associated with increased T2-signal. The native T1 relaxation time is elevated at 1100ms which is elevated. Taken together these, findings are atypical for prior myocardial infarction and are consistent with the diagnosis of cardiac sarcoidosis in the inflammatory stage. Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 50 ml/m2 (normal range 69+/-14), the RVEDV is 100 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 55 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 mitral regurgitation noted.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 mildly dilated (31mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsRight lung with post surgical changes and volume loss. There is a small layering right pleural effusion. There are diffuse bilateral infiltrates and emphysematous changes of the lungs. 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. Severely dilated left ventricle with moderately reduced systolic function (EF 34%). 2. There is a patch of late gadolinium enhancement involving the basal inferior wall but sparing the endocardium. The burden of late gadolinium enhancement involves approximately 5% of the myocardium. This region is additionally associated with increased T2-signal. Taken together these, findings are atypical for prior myocardial infarction and are consistent with the diagnosis of cardiac sarcoidosis in the inflammatory stage. 3. Normal size right ventricle with mildly reduced systolic function (EF 45%).4. Moderate mitral regurgitation. 5. Extracardiac findings as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.