A 74 year old female with personal history of systemic hypertension, deep vein thrombosis, GERD, pancreatitis, gallstones and systemic sarcoidosis (skin and lung). Recently had a syncope, the ECG showed sinus rhythm RBBB, the echocardiography showed normal left and right ventricular function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 67 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma.No accelerated flow was seen in the LVOT. There is no thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). 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 trace 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is rounded atelectasis of the right lower lobe. Mild splenomegaly. There is a low signal focus in the area of the gallbladder; this finding was better characterized on previous CT studies.
1. The left ventricle is normal in size and systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle into the interventricular septum. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma. 3. The right ventricle is normal in size and systolic function, the RVEF is 52%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.