A 71 years old male with previous CABG and cardiopyopathy with severely reduced left ventricular ejection fraction, ICD recently extracted because of infection. Referred to MRI to evaluate etiology Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 209 ml (normal range 142+/-34), the LV end systolic volume index is 84 ml/m2 (normal range 25+/-9), the LVESV is 147 ml (normal range 47+/-19), the LV mass index is 121 g/m2 (normal range 85+/-15), and the LV mass is 211 g (normal range 164+/-36). There is global hypokinesis with akinesia of the apical 1/2 of the anterior wall. There is late gadolinium enhancement that is near transmural at the apical 1/4 of the anterior wall which is likely nonviable. The anteroseptum is also akinetic and demonstrates intermediate signal abnormality suggestive of near transmural infarct. The apical septum demonstrates subendocardial high signal compatible with infarct, approximately 50% wall thickness, likely viable. There is a focal, transmural infarct involving the inferior wall from mid chamber to apex which is akinetic. The remainder of the inferior wall and lateral wall are severly hypokinetic.There is no intracardiac thrombus.Left AtriumThe left atrium is normal in size. There is leftward bowing of the interatrial septum that does that does not meet criteria for aneurysm. No associated flow jet in either atria is noted.Right VentricleThe right ventricle is small in size with normal systolic function. Because of the small size and limited slices available for postprocessing, the calculation of EF may be inaccurate. However, by visual estimation, the estimated qualitative EF is 60%.There is no evidence infarct.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve leaflets demonstrate diffuse calcification and thickening. There is limited opening, indicative of a degree of stenosis; flow quantification was not performed above the annulus. There is aortic regurgitation, mild by quantification (15%).Mitral ValveThe mitral valve opens widely and there is mild 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 normal 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 FindingsSusectibility artifact from sternal wires are present. There is a left chest wall hematoma that contains two components of different signal, most likely due to various age of development. The largest component measures 4.4 x 10.1 cm. The more inferior component measures 4.5 x 6.7 cm (401/6). There is a saline bag resting on the skin of the left superior anterior chest wall, overlying these hematomas. Posterior to the hematomas, there is signal abnormality that is suggestive of a post operative pocket following ICD pulse generator excision.Incidentally, there are several foci of right-sided, nodular pleural thickening (301/ 25,27). The etiology is unclear, possibly postinflammatory or neural in origin. These can be better characterized with CT thorax.There is atherosclerosis of the descending thoracic aorta.
1. The left ventricle is moderately dilated with severely reduced systolic function, LVEF 29%. There is global hypokinesis with regional akinesis at areas of infarct. There is no MRI evidence of eosinophilic myocarditis.2. The right ventricle is small in size with normal systolic function. No right sided infarct.3. Trileaflet aortic valve with a degree of stenosis which was not quanitfied. Associated aortic regurgitation, mild by quantification (15%).4. Nodular right-sided pleural thickening which can be better characterized with CT thorax.