Case of the week

1
Case of the week 08-13 Viral Myocarditis by CMR
History A 22-year-old college student noted
chest pain one week after recovering from
flu-like symptoms. His ECG revealed
inferolateral ST-elevation and his cardiac
biomarkers were elevated. Transthoracic
echocardiography regional left ventricular
dysfunction with focal hypokinesis of the mid
inferior and inferolateral walls (E). CMR
Coronary MR imaging demonstrated unobstructed
proximal coronary arteries (images A,B).T2
weighted fast spin echo demonstrated increase
inferolateral and lateral signal intensity
(arrow, image C). Mid zone and epimyocardial LGE
was present in the mid-inferior and lateral walls
(arrow, image D). Cine CMR confirmed the finding
of regional left ventricular dysfunction with
hypokinesis of the inferior, inferolateral, and
lateral walls (E). (1,2) Discussion These
images, in concert with the clinical
presentation, support a diagnosis of focal
myocarditis following viral illness.
E
F
1.Laissy JP, Hyafil F, Feldman LJ, et al.
Differentiating acute myocardial infarction from
myocarditis diagnostic value of early- and
delayed-perfusion cardiac MR imaging. Radiology
200523775-82. (full text)
2.Mahrholdt H, Goedecke C, Wagner A, et al.
Cardiovascular magnetic resonance assessment of
human myocarditis a comparison to histology and
molecular pathology. Circulation
20041091250-1258 (full text)
Gregory Piazza and Warren J. Manning, Beth Israel
Deaconess Medical Center, Boston Mass. USA
Handling editors M Westwood/Gary Cooper