A 37 year old female with breast cancer and bones metastasis after chemotherapy presenting with heart failure symptoms while the echocardiography showed severely decreased left ventricular function. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 247 ml (normal range 109+/-23), the LV end systolic volume index is 103 ml/m2 (normal range 18+/-5), the LVESV is 207 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 129 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no late gadolinium enhancement.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderate to severe systolic dysfunction. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 154 ml (normal range 110+/-24), the RV end systolic volume index is 55 ml/m2 (normal range 22+/-8), and the RVESV is 110 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 mitral regurgitation, visually estimated to be mild. Dedicated imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is visually estimated trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal 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 pericardial effusion.Extracardiac FindingsDiffuse osseous metastases are better characterized on the recent CT thorax. A right port catheter is present with the tip located at the superior caval atrial junction. Small hiatal hernia. While this is not specifically designed for evaluation of the hepatic parenchyma, there are foci of high signal scattered throughout the liver. For example on series 301 images 4 and 7, there are high signal foci raising the question of metastases. This can be better characterized with contrast-enhanced MRI, if clinically appropriate.
1. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 16%. There is global hypokinesis with regional variation. 2. Foci of high signal in liver raise the question of metastases. This can be better characterized with contrast-enhanced MRI, if clinically appropriate3. The right ventricle is normal in size with moderate to severe systolic dysfunction, the RVEF is 28%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.