53 year old male with recent diagnosis of pulmonary sarcoidosis, and biventricular dysfunction. Referred for cardiovascular MRI to evaluate for cardiac sarcoid. Left VentricleThe left ventricle is mildly dilated with severely depressed systolic function. There is severe global hypokinesis with systolic and diastolic septal flattening. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 187 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 171 g (normal range 164+/-36). There is late gadolinium enhancement of the inferior RV insertion point. The pattern is well described in patients with pulmonary hypertension. There is also a mid-wall/epicardial stripe of late gadolinium enhancement involving the basal to mid septal wall. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding supports the diagnosis of cardiac sarcoidosis but it is unclear whether it represents sarcoid in the inflammatory stage or in the fibrotic stage. Cardiac FDG-PET may be helpful to differentiate these possibilities. No LV apical thrombus is noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 11%, the RV end diastolic volume index is 179 ml/m2 (normal range 82+/-16), the RVEDV is 384 ml (normal range 142+/-31), the RV end systolic volume index is 159 ml/m2 (normal range 31+/-9), and the RVESV is 341 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate 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 (34mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLymph nodes and lung changes consistent with sarcoid noted. 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. Mild LV dilation with severely reduced systolic function (LVEF 17%).2. Severe RV dilation with severely reduced systolic function (RVEF 11%). Systolic flattening of the interventricular septum suggesting increased RV systolic pressure.3. There is late gadolinium enhancement of the inferior RV insertion point. The pattern is well described in patients with pulmonary hypertension. There is also a mid-wall/epicardial stripe of late gadolinium enhancement involving the basal to mid septal wall. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding supports the diagnosis of cardiac sarcoidosis but it is unclear whether it represents sarcoid in the inflammatory stage or in the fibrotic stage. Cardiac FDG-PET may be helpful to differentiate these possibilities. 4. Severe right atrial dilation.5. At least moderate tricuspid regurgitation. Findings discussed with Dr. Estrada.