63 year old man with history of OHT, referred for evaluation of possible inflammatory/infiltrative process (possible rejection?) in setting of new LV dysfunction. Left VentricleThe left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 104 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19), the LV mass index is 76 g/m2 (normal range 85+/-15), and the LV mass is 122 g (normal range 164+/-36). LV systolic dysfunction is global. There is an area of patchy late gadolinium enhancement in the basal inferior wall which may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time in the basal septum is 1063ms and in the basal inferior wall is 1150ms (elevated). The elevation in T1 time in the basal inferior wall may also be indicative of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of significant edema on T2 STIR imaging or evidence of early gadolinium enhancement on T1 BB imaging.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 86 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 45 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" brachiocephalic branching pattern (normal variant). 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 FindingsThe left hemidiaphragm is elevated. There is pleural/parenchymal scarring of the right lung base. There is a 1.3cm x 0.7cm nodule in the right lung fissure, likely a parenchymal lymph node. 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 normal in size with mildly decreased systolic function. The overall LV ejection fraction is 47%.2. There is an area of patchy late gadolinium enhancement in the basal inferior wall which may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time in the basal septum is 1063ms and in the basal inferior wall is 1150ms (elevated). The elevation in T1 time in the basal inferior wall may also be indicative of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%.