29 year old with history of ALL, diabetes and VTE presenting from outside hospital with NSTEMI. Coronary angiography performed with no evidence of obstructive coronary disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 112 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 47 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 75 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is two very small areas of late gadolinium enhancement in the basal inferior wall and the mid inferior wall in a pattern that is atypical for myocardial infarction. There are additionally small patchy areas of mildly increased native myocardial T1 relaxation times. This pattern represents a mild underlying myocardial fibrosing, infiltrative, or inflammatory process. It is most suggestive of either a process such as vasculitis or mild myocarditis. Left AtriumThe left atrium is normal in size. Right 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 72 ml/m2 (normal range 82+/-16), the RVEDV is 116 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).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 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 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. Normal left ventricular systolic size and function (LVEF65%).2. There are two very small focal areas of late gadolinium enhancement as described above. The finding could be due to either mild fibrosis, inflammation, or infiltration. The pattern of late gadolinium enhancement raises the possibility of vasculitis or myocarditis. The finding is atypical for prior myocardial infarction.3. Normal RV size and systolic function (RVEF52%). 