Presentation
Young woman with atypical chest pain. Normal ECG with elevated troponin (0.74 ng/ml). Normal echocardiogram.
Patient Data
Focal transmural edema of the myocardium (20 mm) in the inferior medial segment of the left ventricle. No pericardial effusion.
T1WI: No signal alteration
T2WI: High signal in the inferior medial segment of the LV
T2 fat sat: High signal in the inferior medial segment of the LV
LGE: Transmural focal LGE in the inferior medial segment of the LV
NORMAL VENTRICULAR FUNCTION (in this case)
LEFT VENTRICLE: RIGHT VENTRICLE:
EDVi (ml/m²) 64 (V.N. 41 - 81) 71 (V.N. 48 - 87)
ESVi (ml/m²) 29 (V.N. 12 - 21) 37 (V.N. 11 - 28 )
SVi (ml/m²) 34 (V.N. 26 - 56) 34 (V.N. 27 - 57)
EF (%) 53 (V.N. 56 - 78) 48 (V.N. 47 - 80)
Case Discussion
Suspected myocarditis is one of the most frequent indications for cardiac MRI and the only imaging modality that allows for assessing myocardial edema. The use of contrast agent-sensitive sequences acquired ≥10 minutes after injection of Gadolinium (LGE = late Gd enhancement) can visualize irreversible injury (necrosis in the acute setting and scar at a chronic stage) as areas with high signal intensity.