Acute myocarditis

Case contributed by Dr Tamara Razon Cuenza

Presentation

Chest pain with recent hospital admission for acute gastroenteritis. Diffuse ST-segment elevation on ECG and markedly elevated troponin.

Patient Data

Age: 30 years
Gender: Male
MRI

Cardiac MRI

Inhomogeneous myocardial signal intensity on cine SSFP imaging and hyperintense T2W myocardial signal abnormalities in the lateral wall of the left ventricle (LV) indicative of edema. 

Non-ischemic pattern of late gadolinium enhancement (LGE) of the LV myocardium which is predominantly midwall in distribution in the basal to mid anterolateral, inferolateral, and inferoseptal segments and the apical lateral segment most pronounced along the inferolateral wall. Minimal overlying pericardial effusion and pericardial enhancement.

Normal LV dimension with preserved overall systolic function. 

The above findings meet CMR-based criteria for myocardial inflammation and are consistent with an episode of acute myopericarditis. 

Annotated image
  • myocardial edema (arrowhead - STIR)
  • patchy intramyocardial and subepicardial, and overlying pericardial late gadolinium enhancement (arrowheads - LGE)

Case Discussion

Acute myocarditis is an inflammation of the heart muscle commonly of viral etiology.

Diagnostic cardiac MRI (CMR) criteria are based on the demonstration of edema, hyperemia, and necrosis in the myocardium (Lake Louise criteria). 

The typical late gadolinium enhancement (LGE) pattern is subepicardial and mid myocardial involving the lateral wall of the left ventricle and the interventricular septum.

 

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Case information

rID: 77023
Published: 5th May 2020
Last edited: 13th May 2020
System: Cardiac
Inclusion in quiz mode: Included

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