64 year old female with a history of AL Amyloidosis. She is referred for cardiac MRI for follow-up. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 46 ml (normal range 31+/-10), the LV mass index is 69 g/m2 (normal range 67+/-11), and the LV mass is 143 g (normal range 114+/-24). There are no regional wall motion abnormalities present. No evidence of inflammation or edema on T2 stir. Normal gadolinium kinetics. There is left ventricular hypertrophy. Thebasal anteroseptum is 14mm (similar to reported on previous study dated 4/2015). Stable enhancement of the basal to mid inferior/inferolateral wall (when compared with 2013 and 2015 CMR). No intracardiac thrombus. T1(septum) 1141ms and T1 cavity 1599 ms. T1 values are slightly high in the septum where no late gadolinium enhancement was seen. This could be normal or related to diffuse fibrosis.Left AtriumThe left atrium is dilated.Right VentricleThe right ventricle isnormal in size and systolic function.The overall RV ejection fraction is 55%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 170 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation. The main PA is mild-moderately dilated and measures 36 mmTricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries. The thoracic aorta 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 a small pericardial effusion.Extracardiac FindingsWell-circumscribed lesions noted in the liver. 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. The left ventricle is normal in size and function. LVEF is 66%. There is stable enhancement of the basal to mid inferior wall. This is atypical for cardiac amyloid and for myocardial infarction. It could be related to prior scar from myocarditis. In this setting with small pericardial effusion, increase in wall thickness, the possibility of localized cardiac amyloid cannot be excluded. Elevated myocardial T1 time.3. The right ventricle isnormal in size and function. RVEF is 55%4. Biatrial enlargement5. At least mild mitral and tricuspid regurgitation