61 year old man with cardiomyopathy referred to evaluate for etiology. 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 143 ml/m2 (normal range: 74+/-15), the LVEDV is 272 ml (normal range 142+/-34), the LV end systolic volume index is 95 ml/m2 (normal range 25+/-9), the LVESV is 181 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 190 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is late gadolinium enhancement involving the epicardial basal inferolateral wall and the mid-myocardial septum. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern has been commonly been described in dilated cardiomyopathy and healed myocarditis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 229 ml (normal range 142+/-31), the RV end systolic volume index is 77 ml/m2 (normal range 31+/-9), and the RVESV is 146 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 mild to 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a wedge-shaped, pleural-based finding consistent with mass/infiltrate/ infarction. It was also present on recent chest CT scan. 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 moderately reduced systolic function (LVEF 34%). There is late gadolinium enhancement, as described above, in a pattern that is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The pattern of late gadolinium enhancement has been commonly described in dilated cardiomyopathy and healed myocarditis. 2. Mild right ventricular dilation with moderately reduced systolic function (RVEF 36%).3. Severe left atrial dilation.4. Mild to moderate tricuspid regurgitation.5. See extra-cardiac finding. 