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Case History
Teenager awoken by chest pain.
Case Detail
| Anatomy: Chest |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Infectious-Inflammatory |
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| Created: over 6 years ago |
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| Updated: over 5 years ago |
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| Tags:
PEDS
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| Modality/Study Types:
MR
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Activities:  PDF  ImageJA |
Case Images
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Reveal Clinical Notes
ST segment elevation on EKG. Elevated troponin levels.
Reveal Findings
MR – Short and long axis views show hyperintensity in the inferior and posterior wall with minimal pericardial irritation.
Reveal 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.
Reveal Diagnosis
Viral Myocarditis