Myocarditis

Case contributed by Tim Luijkx

Presentation

History of myocarditis, most likely giant cell myocarditis.

Patient Data

Age: 35
Gender: Female
mri

Patient characteristics:
Length 158 cm. Weight 49 kg. Body surface area 1,47 m² (Dubois en Dubois).

Synchronous, adequate contraction of both ventricles. Diffuse thickening of LV wall. Edema of the LV wall on T2 SPIR-weighted images, over twice the signal intensity of skeletal muscle. Poor diastolic filling with only an A peak measured over the mitral valve (not shown), likely due to diffuse wall thickening.

Myocardium cannot be properly suppressed, suggestive of myocardial edema. On viability series there is diffuse late enhancement of myocardium with additional patchy areas of late enhancement in the anteroseptal and inferoseptal LV wall. 

Moderate pericardial effusion with slight pericardial enhancement.

Cardiac dimensions:
- LV: 32 mm
- RV: 23 mm
- LV wall: diffuse thickening of LV wall, inferoseptal 14 mm, inferior 13 mm, elsewhere 12 mm

Functional parameters LV:
- EDV 66 ml (45 ml/m²)
- ESV 30 ml (21 ml/m²)
- SV 36 ml (25 ml/m²)
- EF 54%
- Cardiac output 4.9 l/min (3.3 l/(min*m²))
- Myocardial mass 66 g (45 g/m²)

Functional parameters RV:
- EDV 49 ml (33 ml/m²)
- ESV 17 ml (12 ml/m²)
- SV 32 ml (21 ml/m²)
- EF 64%
- Cardiac output 4.3 l/min (2.9 l/(min*m²))

Q-flow measurement (not shown):
- Mitral valve: forward volume 25 ml; peak velocity 72 cm/sec; regurgitation fraction 30% calculated, however visually only slight inssuficiency (probably not measured in the right plane).

Conclusion:
Findings consistent with acute myocarditis with a minor pericarditis component.

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