Acute myocarditis

Case contributed by Sigmund Stuppner
Diagnosis certain

Presentation

Young woman with atypical chest pain. Normal ECG with elevated troponin (0.74 ng/ml). Normal echocardiogram.

Patient Data

Age: 40 years
Gender: Female

Cardiac

mri

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:

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.

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