49 year old male with a history of chemotherapy induced cardiomyopathy, presenting with acutely reduced LVEF. Referred for cardiovascular MRI to evaluate for myocarditis vs. CAD. Left VentricleThe left ventricle is normal in size with severely reduced systolic function. There is severe hypokinesis of the lateral wall and near-akinesis of all other regions, as well as diffusely thinned myocardium. An apical thrombus is noted, measuring 18mm x 10mm, with a thick stalk which appears affixed to the subendocardial apical wall. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 103 ml (normal range 142+/-34), the LV end systolic volume index is 67 ml/m2 (normal range 25+/-9), the LVESV is 158 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 95 g (normal range 164+/-36). There is no late gadolinium enhancement of myocardial infarct, fibrosis or inflammation.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 66 ml/m2 (normal range 31+/-9), and the RVESV is 157 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is trace 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 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. There is no evidence of central pulmonary embolus.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac Findings1. Large loculated right pleural effusion which has increased in size and become more organized when compared to CT on 12/4/14. There is also a small left pleural effusion.2. Multiple large lymph nodes in the right axilla, stabe size of partially calcified lymph nodes in the anterior mediastinum.3. A 1.5 cm low-signal lesion is seen in the lateral spleen, more conspicuous than on prior CT, raising question of a metastasis.4. T2 high signal of two vertebral bodies which are new, suggestive of osseous metastases. One at approximately T3 is punctate left of midline, the second is also left of midline, of approximately 40% of the L1 vertebral body.Findings were discussed with resident caring for the patient at 1307hrs.
1. Left ventricle is normal in size with global, severely reduced systolic function, with regional variation as described above (LVEF 22%). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The appearance is suggestive of a dilated cardiomyopathy, possibly secondary to chemotherapy.2. An apical thrombus measures 18mm x 10mm with a stalk affixed to the apical subendocarium. 3. Right ventricle is normal in size with severely reduced systolic function (RVEF 23%).4. Mild tricuspid regurgitation and mild to moderate mitral regurgitation.5. High signal within two vertebral bodies which are new, suggestive of osseous metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.