Ultrasound revealed right-sided pleural effusion and ascites and lack of flow in the portal veins, suggestive of hepatitis.
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The IVC is enlarged with a significant contrast reflux. There is ascites throughout the abdomen and pelvis. There is engorgement of the SMV. Bilateral pleural effusions noted.
The CTPA was normal.
There is subtle hyper-enhancement of the wall of the left ventricle, with the Hounsfield units measuring ~98. The phasing of this scan is abnormal, due to the altered cardiac function, however the myocardium is rarely seen to enhance above ~65 units Hounsfield units.
The CT findings of venous engorgement of the IVC and SMV, in conjunction with the significant reflux of contrast into the IVC and the ascites, are suggestive of heart faliure, possibly secondary to myocarditis in view of the myocardial hyper-enhancement.
Importantly, there is no thrombus within the IVC and the inhomogeneous enhancement within it are a result of abnormal mixing. This is partly due to the increased venous pressures within the IVC.
An echocardiogram confirmed the diagnosis of acute myocarditis.
Case presented with Dr. Julian Hague FRCR Interventional Consultant UCLH