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|Number COVID 20-01: CMR Findings in COVID-19 Associated Myocarditis|
CMR Findings in COVID-19 Associated Myocarditis
Jonathan W. Weinsaft MD, Jonathan Kochav MD, Jiwon Kim MD
Memorial Sloan Kettering Cancer Center
Weill Cornell Medical College
Clinical History: A 36 year old woman was admitted with pleuritic chest pain in the context of an acute COVID-19 infection. She was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by a positive reverse transcriptase PCR. Troponin-I was elevated at 13 ng/mL, and the D-dimer and other inflammatory biomarkers were elevated. She had a normal ECG with normal sinus rhythm, normal intervals, and no ST-T wave changes. Her echocardiogram showed moderately decreased left ventricular systolic function with global hypokinesis and mild right ventricular dilation and mildly decreased systolic function.
Movie 1: Two chamber left ventricle cine SSFP with moderately decreased left ventricular systolic function.
Movie 2: Four chamber cine SSFP with moderately decreased left ventricular systolic function.
Movie 3: Three chamber left ventricle cine SSFP with moderately decreased left ventricular systolic function.
Figure 1: T2 spin echo short axis mid slice with increased signal in the lateral wall.
Figure 2: Short axis stack myocardial delayed enhancement with basal lateral wall epicardial late gadolinium enhancement (yellow arrow).
Conclusion: CMR findings were consistent with myocarditis in the setting of COVID-19 infection. She was treated with IV methylprednisolone for two days followed by a rapid prednisone taper.