56 year old man with asymmetric septal hypertrophy referred to evaluate for etiology. Left VentricleThe left ventricle is normal in size with normal systolic function. The is asymmetric hypertrophy of the interventricular septum. The maximum wall thickness is at the mid anteroseptum and is 19mm. The posterior wall thickness is 7mm. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a patch of endocardial non-transmural late gadolinium enhancement involving the basal anteroseptum. The pattern is somewhat atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. No evidence of systolic anterior motion of the mitral leaflets. 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 pseudobovine 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 FindingsThis 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 asymmetric hypertrophy of the left ventricle with normal systolic function (LVEF 58%). The maximum wall thickness is 19mm. There is a small burden of atypical late gadolinium enhancement in the basal anteroseptum consistent with the presence of underlying myocardial fibrosis, inflammation, or infiltration. Taken together, these findings are most consistent with the diagnosis of hypertrophic cardiomyopathy. 2. Normal right ventricular size and systolic function (RVEF 60%).3. No evidence of systolic anterior mitral annular motion or left ventricular outflow obstruction.4. Mild biatrial dilation. 