Impression:
Markedly increased LV volume (3+).
Mild reduced uptake in the inferior wall - most likely attenuation artifact (white arrows) .
Minimal nondiagnostic changes in the inferior lateral wall with stress (green arrow with "?") .
Discrepancy between LV volume and "perfusion abnormality" suggestive of LV volume overload condition (CMP ?, valve disease ?).
ECHO:
Aortic valve regurgitation 4+/4+
Coronary angiography
RCA - 50% stenosis
LAD - 50% stenosis; 1st Diagonal - 80% stenosis
Severe LV dilatation
Comments:
The mild reduced uptake in the inferior wall is of attenuation type (smooth, 5 to 7 o'clock) .
This patient is relatively small and does not have a wide chest. However, the LV cavity is very large, the ED diameter is in order of 7-8 cm. There is thus a large volume of blood through which the photons from the inferior wall will have to travel to reach the camera.
The half value layer for 140 keV photons in water (blood) is about 4.5 cm.
Large LV cavities often produce significant self attenuation.
