Case from: Gregory Piazza and Warren J. Manning, Beth Israel Deaconess Medical Center, Boston Mass. USA
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. TTE: regional left ventricular dysfunction with focal hypokinesis of the mid inferior and inferolateral walls (bottom left).
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 (bottom right). (1,2)
Discussion: These images, in concert with the clinical presentation, support a diagnosis of focal myocarditis following viral illness.
References: 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 2005;237:75-82. (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 2004;109:1250-1258 (full text)