Acute perimyocarditis

Case contributed by Sigmund Stuppner

Presentation

Chest pain with augmented leukocytes, Troponin I ( > 24000 pg/ml) and CK (1000 U/L). Echocardiography findings: normal cardiac function, mild tricuspid insufficiency and minimal pericardial effusion. Normal ECG.

Patient Data

Age: 20 years
Gender: Male
mri

Prevalent linear intramyocardial and partial subepicardial late gadolinium enhancement (10 min) in the basal and medial anterior, anterolateral, inferolateral and inferior wall of the left ventricle with no coronary distribution. Associated transmural edema in STIR images. Minimal pericardial effusion.

                                                   LEFT VENTRICLE:                  RIGHT VENTRICLE:
EDVi (ml/m²)                            70 (V.N.  47 - 92)                   81 (V.N. 55 - 105)                   
ESVi (ml/m²)                            20 (V.N. 13 - 30)                    27 (V.N. 15 - 43 )
SVi (ml/m²)                               50 (V.N. 32 - 62)                    53 (V.N. 32 - 64)
EF (%)                                        70 (V.N. 56 - 78)                    67 (V.N. 47 - 74)

Normal ventricular function.

Case Discussion

CMR allows an excelent evaluation of several features of myocarditis, like inflammatory hyperemia and edema, necrosis/scar, contractile dysfunction, and accompanying pericardial effusion.

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