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