68 year old man with history of pericarditis, coronary disease and recurrent 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 63%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 42 g/m2 (normal range 85+/-15), and the LV mass is 86 g (normal range 164+/-36). The myocardial:skeletal T2 ratio is normal (=2). There is late gadolinium enhancement in the basal inferior wall which involves the subendocardium and is in a pattern consistent with prior myocardial infarction. This was seen on prior cardiac MRI and is better visualized on today's study. The native T1 relaxation time is normal (1020ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 139 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 71 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 trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine branching pattern. The aortic root is mildly dilated (ascending aorta 42mm).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 a small pericardial effusion. When compared to the previous study of 12/2015, there is focal thickening overlying the inferior, inferolateral and lateral walls of the left ventricle and there is prominently increased T2 signal, suggestive active pericarditis. There is also prominent late gadolinium enhancement in this same region. There is mild pericardial to myocardial tethering without evidence of variation in the septal position during respiration. These changes suggest recurrent active pericarditis without constrictive physiology.Extracardiac FindingsPreviously reported nodule located between the LV and pulmonary artery is a surgical clip from LIMA anastomosis site. Trivial left pleural effusion. 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. There is pericardial thickening with evidence of active inflammation and mild tethering to the myocardium but no evidence of constrictive physiology. These changes have worsened when compared to the prior MRI study from 12/2015.2. Normal LV size with systolic function (LVEF 63%) with evidence of a small, non-transmural myocardial infarction which is unchanged from before.3. Normal RV size with low normal systolic function (RVEF 49%).4. Mild aortic root dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.