38 year old man with history of schizophrenia (medically treated), admitted with left sided chest pain with course complicated by reported polymorphic VT arrest, successfully resuscitated and found to have coronary disease (obtuse marginal branch) s/p PTCA. Referred for cardiac MRI prior to ICD placement to evaluate for scar and structural heart 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 66 ml/m2 (normal range: 74+/-15), the LVEDV is 156 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 153 g (normal range 164+/-36). There is mild left ventricular hypertrophy (basal septal thickness 13mm, posterior wall thickness 12mm). There is tardokinesis of the basal inferior and basal inferolateral wall. There is prominent hyperintense T2-STIR signal (myocardial:skeletal ratio >2) in the basal inferior/inferolateral wall which is transmural. Global relative enhancement is normal (<4). There is also prominent, high signal late gadolinium enhancement noted in the basal inferior/inferolateral wall which appears transmural at the base, but spares the subendocardium towards the mid segments. This could be consistent with acute myocardial infarction, but atypical causes of myocardial inflammation are still on the differential. No gross evidence of inter-myocardial hemorrhage in the infarct region. There is no LV thrombus. 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 63%, the RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVEDV is 136 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 51 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 pseudobovine 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 drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion. There is no evidence for pericardial edema or inflammation. 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 size with mild left ventricular hypertrophy and normal systolic function (EF 65%). 2. There is tardokinesis of the basal inferior and inferolateral wall with preserved wall thickness. In these segments, there is associated late gadolinium enhancement which is predominantly transmural and associated with significant active myocardial edema by T2-STIR imaging. Taken together with the clinical history, this likely represents a recent focal myocardial infarction. However, atypical causes of infiltrative/inflammatory myocardial disease in this young patient should still be considered, such as myocarditis or sarcoidosis.3. Normal size right ventricle with normal systolic function (63%). 4. Trivial pericardial effusion 