67 year old man with history of AL amyloid, referred for evaluation of cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 126 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 41 g/m2 (normal range 85+/-15), and the LV mass is 78 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The native myocardial T1 time in the interventricular septum is 1093 ms. Values between >1100 may indicate possible cardiac amyloid. There is a possible area of late gadolinium enhancement in the mid-myocardial lateral wall in a pattern that is not typical of myocardial infarction. This pattern is also not typical of amyloidosis. It could suggest an suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 133 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 46 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 mild 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are multiple lesions in the liver the largest measuring 7.9 x 8cm. Recommend clinical correlation and consideration of further dedicated abdominal imaging (ultrasound or CT) 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 with normal systolic function. The overall LV ejection fraction is 70%2. There is a possible small area of late gadolinium enhancement in the mid-myocardial lateral wall in a pattern that is not typical of myocardial infarction or cardiac amyloidosis.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%4. Multiple well-circumscribed lesions noted in the liver. If clinically indicated, a separate dedicated evaluation should be considered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.