68 year old man with history of multiple myeloma, referred for evaluation of possible underlying cardiac amyloid. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 44% the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 273 ml (normal range 142+/-34), the LV end systolic volume index is 64 ml/m2 (normal range 25+/-9), the LVESV is 154 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 188 g (normal range 164+/-36). There is moderate concentric LVH (13mm wall thickness). There is abnormal septal motion due to left bundle branch block. The IVS myocardial T1 time is 917ms (normal range) and the ECV fraction is 21% (normal range). There is a small epicardial patch of late gadolinium enhancement in the basal anterolateral wall. The pattern is atypical for infarction and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Given the normal native myocardial T1 times, the normal ECV fraction, and the small epicardial pattern of late gadolinium enhancement, the diagnosis of cardiac amyloidosis is less likely. Left AtriumThe left atrium is mildly dilatedRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in sizeAortic 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 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 atelectasis or infiltration in the left lower lung. 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. Moderate concentric left ventricular hypertrophy with mild LV dilation and mildly reduced systolic function (LVEF 44%). There is a small amount of epicardial late gadolinium enhancement involving the basal anterolateral wall. The finding is atypical for prior myocardial infarction. Additionally, given the normal native myocardial T1 time and normal extra-cellular volume fraction, the finding would also be atypical for cardiac amyloidosis. The finding represents a small amount of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 52%).3. Mild left atrial dilation. 4. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.