Left Ventricle Character

Normal CT

CT scans through the LV in axial projection shows a normal LV in diastole above with an open mitral valve and a rounded apex, and in systole below with a slightly pointed apex and closed mitral valve. The normal end diastolic volume in the LV is about 120 ccs and the normal end systolic volume is between 50ccs and stroke volume  about 70ccs
Tags, LV, CT, systole, diastole,
Ashley Davidoff MD 24839c
At the time of his first presentation with dyspnea his CXR showed perihilar infiltrates.
A CT confirmed progressive alveolar edema, with bilateral effusions (right greater than left), mild left ventricular dilatation, Kerley B lines and centrilobular densities and small pericardial effusion. Ashley Davidoff MD
This is a CT of the chest at the level of the heart demonstrating a curvilinear calcification at the apex of the left ventricle. This calcification is most likely in the myocardium of the apex of the left ventricle, caused by dystrophic calcification of infarcted myocardial tissue. Alternatively it may be within thrombus in the LV apex, secondary to an aneurysm of the apex. The shape of the calcification medially as it courses up the septum, makes pericardial calcification unlikely. In addition a faint soft tissue density of normal pericardium can be seen anterior to the curvilinear calcification. Pericardial calcification is usually present more commonly over the right ventricle. Courtesy Ashley Davidoff MD. 25708 code heart LV apex curvilinear calcification probable remote myocardial infarction cardiac imaging radiology CTscan


The first image on the left is a normal axial MRI of the LV. In the image on the right, the LV cavity is too large, has a rounded and rather full apex, and has thinned septal apical walls. The color overlay shows the expanded LV cavity in the images on the right with the thrombus in the LV apex (green overlay) Courtesy of Ashley Davidoff M.D. 32131
This cross sectional CT image of the heart shows calcified apex of the left ventricle associated with thrombus, characteristic of an LV aneurysm. The cause is almost certainly secondary to coronary artery disease and ischemic heart disease with secondary myocardial infarction. Courtesy Ashley Davidoff MD. 30472 code heart LV apex IHD CAD aneurysm calcification calcified MI cardiac imaging radiology CTscan
This series of non contrast CT scans through the inferior aspect of the LV shows a thin lucency of fat density which is located on the endocardial side of the myocardium. This suggests that there is significant associated thinning of the myocardium. There are a few punctate dystrophic calcifications in the septal component of the lucency. (a,b) The lucent abnormality also extends to the apex and the free wall of the LV. In images c and d the apex bulges forming an apical aneurysm. The findings are consistent with previous infarction with fatty changes in the infarcted region. Courtesy Ashley Davidoff MD. 38325c code cardiac heart LV apex septum free wall lucent fat calcification MI aneurysm CAD IHD imaging radiology CTscan
This series of CT image shows a faint curvilinear lucency in the apical myocardium (a,b) as well as myocardial calcification. The lucency identified by red lines in b, is thought to be a fatty deposition in infarcted myocardial tissue, and the calcification represents dystrophic calcification in the necrotic tissue. Note that the calcification is not in the pericardium which is identified by the red markers in c. The pericardium is surrounded by pericardial at on the outside and epicardial fat on the inside. Included in the differential diagnosis is an apical aneurysm with calcification in clot. The calcification in the annulus is premature and unusual for this 56 year old male patient. Note the small bilateral pleural effusions. Courtesy Ashley Davidoff MD. 29601c01 code CVS cardiac heart MAC apical fat MI calcium myocardium apex cardiac imaging radiology CTscan radiologists and detectives
37 year old male with no history of CAD with a fat containing nodule at the LV apex most likely representing a lipoma of the myocardium
Ashley Davidoff MD
Subendocardial – Ischemia
Subendocardial LGE most commonly ISchemic
Ashley Davidoff MD


48-year-old man with a previous history of sudden loss of vision which subsequently resolved and presents now with near syncope, atrial fibrillation. MRI showed multifocal acute embolic infarcts involving the cerebellum. Echocardiogram showed an enlarged left atrium, significant left ventricular hypertrophy, and moderate mitral regurgitation.
CXR shows LAE and LVE with cephalisation
The MRI shows multifocal linear and nodular LGE at the hinge points (green) in the subepicardial regions (blue) at the base of the heart anteriorly and inferiorly, as well as mid myocardial linear LGE in the septum (pink). The bright LGE is dominant in the nodular form (red)
Diffuse hypokinesis, LVH (95gms/sq m) EF of 39%, moderate mitral regurgitation, and significant left atrial enlargement
Sarcoidosis is though to be most likely together with nonspecific hypertrophic cardiomyopathy . Distribution of LGE is not characteristic of Fabry disease. Amyloidosis is also considered as a less likely possibility
Ashley Davidoff MD
Dilated Cardiomyopathy
2 Chamber LGE sequence shows linear mid myocardial LGE in the ventricular septum
Ashley Davidoff MD


Gated short axis delayed gadolinium sequence through the base LV during diastole and shows subendocardial LGE (red arrowheads in a,b,c, and d, diffuse mid myocardial LGE (white arrowheads) (a,b,c,d) and subepicardial LGE in the RV (yellow arrowheads (b,c)
Ashley Davidoff MD
Characterization of the Left Ventricle using CT and MRI
The collage reveals the variation in the tissue characterization of the LV in disease
Top row (from l to r) Patient with anemia showing low density of the blood and soft tissue density of the thickened myocardium. The 2nd image shows a calcified apical aneurysm. The 3rd image is a calcified aneurysm of the apex with thrombus in the lumen. The 4th image shows fat in the septum and the apex reflecting a previous MI in this region
2nd row 1st image is an MRI showing subendocardial delayed gadolinium enhancement (LGE) in a patient with a prior infarct of the inferolateral portion of the LV. The middle image shows a dilated LV with mid myocardial LGE in a patient with congestive cardiomyopathy. The last image shows multicentric linear and nodular LGE prominent in the subepicardial region and consistent with sarcoidosis.
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Ashley Davidoff MD
Examples of LGE in a Variety of Nonischemic Cardiomyopathies
(Top left) A 4-chamber view of patchy distribution of late midwall and epicardial late gadolinium enhancement (LGE) (arrows) in a patient with cardiac sarcoidosis. (Top right) A 3-chamber view of a midwall stripe pattern of late gadolinium enhancement (arrows) in a patient with dilated cardiomyopathy. (Middle left) A 4-chamber view of patchy epicardial and midwall late gadolinium enhancement along the lateral wall (arrows) in a patient with myocarditis. (Middle right) A midventricular short-axis image in a patient with pulmonary hypertension (HTN) with right ventricular (RV) dilation and hypertrophy (*) along with late gadolinium enhancement in the anterior and inferior right ventricular insertion points (arrows). (Bottom left) A 3-chamber view of a LGE image in a patient with cardiac amyloid. The left ventricular blood pool is nulled (*), and there is subtle circumferential subendocardial late gadolinium enhancement throughout the left ventricle. The late gadolinium enhancement is most pronounced at the base of the left ventricle within hypertrophied myocardium (arrow). (Bottom right) A midventricular short-axis image in a patient with hypertrophic cardiomyopathy with evidence of asymmetrical septal hypertrophy with extensive midwall LGE within the hypertrophied myocardium (arrows). CMP = cardiomyopathy.
Patel A.R. et al
Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy
JACC: Cardiovascular Imaging
Volume 10, Issue 10 Part A, October 2017

See Map of  Left Ventricle