Acute myocarditis

Case contributed by Dr Sigmund Stuppner

Presentation

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

Patient Data

Age: 40
Gender: Female
MRI

Focal transmural edema of the myocard (20 mm) in the inferior medial segment of the left ventricle. No pericardial effusion.

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 Gd (late Gd enhancement-LGE ) 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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Case information

rID: 40718
Case created: 31st Oct 2015
Last edited: 8th Nov 2015
System: Cardiac
Tag: heart
Inclusion in quiz mode: Included

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