Lymphocytic myocarditis

Case contributed by Dr Azza Elgendy

Presentation

66 years old female presented with progressive shortness of breath and syncopal attack for 30 days.

Patient Data

Age: 66 years
Gender: Female
Modality: MRI

Generalized hypokinsia on cine 4CH images.  Cardiomegaly with biatrial enlargement. Abnormal hyperintense signals involving the myocardium on T2 DIR, as compared to the skeletal muscle, the ratio is 3:1 . Early enhancement when comparedT1 DIR pre to post contrast. Patchy mid myocardial LGE associated with subepicardial enhancement. 

Modality: Annotated image

Both images show illustration of the enhancement pattern seen with the myocarditis. This includes patchy mid myocardial as well as sub-epicardial . 

Case Discussion

The findings suggest myocarditis, 2 criteria of Lake Louise consensus, includes T2 myocardium to skeletal muscle signal ratio > 1.9 and delayed myocardial enhancement including sub-epicardial and mid myocardium. The course of the disease was so aggressive that the patient passed away few weeks after the exam. 

Gross Description:  

The specimen is received on saline soaked gauze in a container labeled with   the patient's name and "myocardial biopsy x6" and consists of six fragments of   tan-pink soft tissues ranging from 0.1-0.25 cm in greatest dimension. The  specimen is submitted in toto in one cassette. Please note some of the tissues may not survive processing.

Microscopic Description:  

Histologic evaluation reveals fragments of myocardium with chronic   inflammation including lymphocytes and rare eosinophils.  Rare giant cells are   present.  A Congo red stain is negative for amyloid. Fragments of myocardium are moderately fibrotic and contain a patchy moderately dense chronic inflammatory cell infiltrate comprised predominantly of lymphocytes with a few plasma cells and an occasional eosinophil.  

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Case Information

rID: 48483
Case created: 9th Oct 2016
Last edited: 7th Dec 2016
System: Cardiac
Inclusion in quiz mode: Included

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