59 year old woman with history of lung cancer s/p right pneumonectomy/chemotherapy/chest wall radiation, as well as diabetes, hypertension and hyperlipidemia who presents for cardiac MRI to evaluate for etiologies of LV dysfunction noted on recent echocardiogram.MEDICATIONS: lovenox, furosemide, lantus, lisinopril, nadolol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. There is no evidence for myocardial iron overload. The native T1 relaxation time is ~1030-1040ms, which is within normal limits.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 48 ml/m2 (normal range: 65+/-11), the LVEDV is 92 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 37 g/m2, and the LV mass is 71 g. There is abnormal septal motion noted. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 57 ml/m2 (normal range 69+/-14), the RVEDV is 111 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is moderate to severely dilated. The interatrial septum bulges towards the left suggestive of elevated right atrial pressure.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsTwo left sided pulmonary veins drain normally into the left atrium; the right sided pulmonary veins were ligated during pneumonectomy. Pulmonary ArteryThe main pulmonary artery is normal in size. The right pulmonary artery abruptly ends, consistent with previous ligation during pneumonectomy. Venous AnatomyThe SVC is not well visualized. The IVC is dilated.PericardiumThe pericardium measures ~4mm which is within normal limits. There is no increased T2 signal to suggest pericardial edema. With real-time imaging, there is no exaggerated septal bounce to suggest constrictive physiology is present.Extracardiac FindingsThere is low signal intensity throughout the liver and spleen. Specifically, the T2* relaxation time in the liver is reduced at 14ms. This combined with heterogenous low signal of the liver could suggest hepatic iron overload. The hepatic veins are dilated. There is volume loss of the right lung due to previous surgery with associated mediastinal shift. There are borderline (9 x 10mm) enlarged lymph nodes in the right axilla which appears morphologically abnormal and is of unclear significance. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. There is no myocardial iron overload.3. Normal LV size and systolic function (LVEF 54%)4. Normal RV size and systolic function (RVEF 55%).5. No evidence of pericardial thickening, edema or constrictive physiology.6. Dilated IVC, hepatic veins and interatrial septum bulging all suggestive of elevated right atrial pressures. 7. At least mild tricuspid regurgitation. 8. Extensive right lung/chest wall abnormalities following surgical pneumonectomy. Additionally, there is heterogenous low signal of the liver and spleen with reduced hepatic T2* decay time which supports a diagnosis of hepatic iron overload.9. There are borderline (9 x 10mm) enlarged lymph nodes in the right axilla which appears morphologically abnormal and is of unclear significance.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.