68 year old man with history of pericarditis, continued chest pain, referred for evaluation of continued pericarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 141 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 81 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a small patch of atypical late gadolinium enhancement in the basal inferior wall suggestive of the presence of a prior underlying fibrosing, infiltrative, or inflammatory process. This was seen on prior cardiac MRI and is unchanged. 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 55%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 76 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 psuedo-bovine branching pattern. The aortic root is mildly dilated (ascending aorta 41mm).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 pericardial effusion. The pericardium is mildly thickened, similar to prior study. There is increased signal on T2-weighted imaging and also on late gadolinium enhancement consistent with pericarditis, although it appears less intense than on prior study. Extracardiac FindingsFocal hypointense nodular lesion is noted between the LV and pulmonary artery. This was present on previous study from 10/2015 but was not apparent on 5/2015; this lesion can be reevaluated on future follow-up imaging. Probable renal and hepatic cysts again noted bilaterally. 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. Mild pericardial thickening with evidence of subacute pericarditis. No clear evidence of constriction. Compared to prior, T2 signal appears less intense, indicative of less overall inflammation.2. Normal LV size with systolic function (LVEF 64%) with evidence of a small amount of atypical late gadolinium enhancement involving the basal inferolateral wall, which was also present on the prior study. It suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration.3. Normal RV size and systolic function (RVEF 55%).4. Mild aortic root dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.