57 year old woman with history of LV dysfunction, coronary disease s/p PCI to circumflex, hypertension and diabetes who presents for cardiac MRI as part of diagnostic evaluation for etiologies of her cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 159 ml/m2 (normal range: 65+/-11), the LVEDV is 326 ml (normal range 109+/-23), the LV end systolic volume index is 127 ml/m2 (normal range 18+/-5), the LVESV is 260 ml (normal range 31+/-10), the LV mass index is 76 g/m2 (normal range 67+/-11), and the LV mass is 157 g (normal range 114+/-24). There is global hypokinesis. There is a small amount of late gadolinium enhancement associated with the RV insertion point on the inferoseptum. This is atypical for myocardial infarction. Based on T2 stir images there is no myocardial wall edema.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with mild-moderately reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 96 ml/m2 (normal range 69+/-14), the RVEDV is 196 ml (normal range 110+/-24), the RV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the RVESV is 112 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is at least mild mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (34mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion. Otherwise no obvious pericardial disease.Extracardiac FindingsThere is a ovoid area of intermediate signal intensity in the superior portion of the liver with peripheral enhancement consistent with a hemangioma which measures 46 x 39mm. 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 LV with severely reduced systolic function (EF 20%). There is global hypokinesis. There is a small area of late gadolinium enhancement in the insertion point of the RV in the inferoseptal wall. 2. Mildly dilated RV with mild-moderately reduced systolic function. RVEF 43%3. At least mild mitral regurgitation. 4. Dilated main pulmonary artery5. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.