A 24 year old female with known systemic lupus erythematosus, now hospitalized with chest pain and positive troponin, echocardiography showed normal left ventricular systolic function. Referred to cardiac MRI to evaluate for myocarditis/pericarditis secondary to lupus flare. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 155 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 85 g (normal range 114+/-24). There is mild global hypokinesis in the basal segments. There is subtle, focal myocardial late gadolinium enhancement involving the epicardial portion of the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is additionally increased signal in that region on SSFP imaging suggesting edema vs inflammation. No evidence of myocardial infarction. Normal native myocardial T1-times. The global relative enhancement ratio, the T2-STIR edema ratio and the extracellular volume fraction are in the normal range. These findings suggest normal interstitial fibrosis burden.No intracavitary thrombus was seen.No myocardial iron overload.Left AtriumThe left atrium is normal in size. The LA volume is 75 ml.Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 168 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 84 ml (normal range 35+/-13). 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 mild to moderate mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion without evidence of significant pericardial inflammation or edema.Extracardiac FindingsSeveral large bilateral axillary lymph nodes are noted. 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 low normal systolic function, the LVEF is 52% with evidence of a small amount of subtle late gadolinium enhancement and edema in the basal inferior and inferolateral walls. These findings support the diagnosis of mild myocarditis without evidence of myocardial infarction. 2. The right ventricle is normal in size with low normal systolic function, the RVEF is 50%. 3. There is mild to moderate mitral regurgitation. 4. No evidence of pericarditis.5. Significant bilateral axillary lymph adenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.