A 48 year old female with history of hypertension, obesity, asthma and depression, now hospitalized with new biventricular systolic dysfunction. A chest CT showed suspected right atrial clot. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 113 ml/m2 (normal range: 65+/-11), the LVEDV is 257 ml (normal range 109+/-23), the LV end systolic volume index is 83 ml/m2 (normal range 18+/-5), the LVESV is 190 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 180 g (normal range 114+/-24). There is global severe hypokinesis. There is a focus of enhancement at the apical two thirds of the inferior wall. A channel containing contrast is not visualized on the study state free precession cine images and; therefore, does not appear to represent a diverticulum. It is suspicious for a focal infarct, approximately 70% wall thickness.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 124 ml/m2 (normal range 69+/-14), the RVEDV is 282 ml (normal range 110+/-24), the RV end systolic volume index is 93 ml/m2 (normal range 22+/-8), and the RVESV is 211 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Particular attention is paid to the abnormality recently identified on the chest CT at the posterior wall of the right atrium. While dedicated, contiguous cine 4 chamber images were performed, the patient requested the examination to be terminated before further characterization of this structure could be made. On axial cine series 1601, image 414, this appears to be a single, pedunculated structure arising from the posterior wall of the right atrium, adjacent to trabeculation (8 x 11 mm). A separate crista terminalis is not visualized. Therefore, the differential considerations include a prominent crista terminalis. Less likely, this may represent a small myxoma or a sessile thrombus, if the patient has had indwelling previous catheter. If further dedicated imaging is requested, this can be performed with a cardiac MRI at no additional charge to the patient. Alternatively, an ECG gated CT with limited z-axis coverage can be performed.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 mild 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 pericardial effusion.Extracardiac FindingsRight sided pulmonary high signal within the parenchyma is suggestive of pneumonia, better characterized on recent CT. Minimal left-sided perihilar high signal may represent additional focus of infection. There is evidence of right hilar lymphadenopathy. Small right pleural effusion.
1. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 26%. There is global severe hypokinesis. 2. Focus of high signal on delayed viability sequences at the apical two thirds of the inferior wall is most suggestive of infarct, approximately 75% wall thickness.3. The right atrium is severely dilated. There is a pedunculated structure arising from the posterior wall of the right atrium. A separate crista terminalis is not visualized. Differential considerations include a prominent crista terminalis. If the patient has had indwelling catheter, a sessile thrombus may be considered but is considered less likely. A small myxoma can have a similar appearance but is also considered less likely. If further imaging is required, either dedicated MR imaging or a motility axis ECG gated CT imaging can be performed. The left atrium is moderately dilated. 4. The right ventricle is severely dilated with severely reduced systolic function, the RVEF is 25%. 5. There is mild tricuspid regurgitation.