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Dilated Vestibular Aqueduct
Joseph Junewick, MD FACR
over 7 years ago
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ARSt Case Repository

Viral Myocarditis

Case Detail

Anatomy: Chest
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 4 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

Teenager awoken by chest pain.


Case Images


Diagnosis

Viral Myocarditis

Clinical Notes

ST segment elevation on EKG. Elevated troponin levels.

Findings

MR – Short and long axis views show hyperintensity in the inferior and posterior wall with minimal pericardial irritation.

Discussion

Myocarditis is simply inflammation of the heart muscle. The etiology is varied and may be secondary to a variety of infections, systemic diseases, drugs, and toxins, Viral myocarditis is usually self limited but can lead to chronic dilated cardiomyopathy and sudden cardiac death. Patients often present with chest pain, elevated cardiac enzyme levels, and ECG changes, making differentiation from acute infarction difficult. On contrast enhanced MRI, the presence of focal delayed enhancement in a non–coronary artery distribution together with wall motion abnormalities correlates strongly with acute or subacute myocarditis. The enhancement becomes less intense and more diffuse over time. Myocarditis lesions occur predominantly in the lateral free wall. Contrast enhancement does not typically affect the subendocardium like infarction. Myocardial necrosis of myocarditis is also usually less confluent than infarction.

Reference

Goitein O, Shlomi M, Beinart R, et al. Acute Myocarditis: Noninvasive Evaluation with Cardiac MRI and Transthoracic Echocardiography. AJR (2009); 192:254-258.

Vogel-Claussen J, Rochitte CE, Wu KC et al. Delayed Enhancement MR Imaging: Utility in Myocardial Assessment. Radiographics (2006); 26:795-810.



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