25 year healthy male presenting with new onset chest pain, found to have elevated biomarkers, cardiac CMR ordered to evaluate for myocarditis or pericarditis. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. There is mild hypokinesis of the basal inferolateral wall. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 243 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 161 g (normal range 164+/-36). There are an atypical pattern of epicardial/ mid-myocardial late gadolinium enhancement that involves the basal to mid inferior wall, basal inferolateral wall, and the apical lateral wall. The basal inferolateral wall has increased T2-signal which suggests the presence of active inflammation/ edema. These abnormalities are highly suggestive of myocarditis and not consistent with myocardial infarction.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 105 ml/m2 (normal range 82+/-16), the RVEDV is 224 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 119 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 trace 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 brachiocephalic branching pattern. The aortic root is normal in size. The left main and right coronary arteries originate normally from the aortic root.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 mild pericardial enhancement along the basal portion of the heart. A trivial pericardial effusion is noted. Extracardiac FindingsResidual thymus tissue is 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 mildly reduced systolic function (LVEF 41%) with mild hypokinesis of the basal inferolateral wall.2. There are an atypical pattern of epicardial/ mid-myocardial late gadolinium enhancement that involves the basal to mid inferior wall, basal inferolateral wall, and the apical lateral wall. The basal inferolateral wall has increased T2-signal which suggests the presence of active inflammation/ edema. These abnormalities are highly suggestive of myocarditis and not consistent with myocardial infarction. 3. Normal RV size with mildly reduced systolic function (RVEF 47%).4. Mild pericardial gadolinium enhancement suggestive of mild pericarditis.