Case Session 04: Miscellaneous (2018)-Resting perfusion defect in a case of acute fulminent myocarditis

Resting perfusion defect in a case of acute fulminent myocarditis

Video Transcription

Video Summary

A 13-year-old girl presented with fever, chest pain, elevated troponin, ECG changes, and mild LV dysfunction, suggesting myocarditis. Cardiac MRI showed diffuse edema and reduced function, but also an unexpected subendocardial apicolateral perfusion defect with early and late gadolinium enhancement, raising concern for coronary disease. Cardiac catheterization showed normal coronaries, and biopsy confirmed lymphocytic/histiocytic myocarditis with myocyte necrosis. She briefly required VA ECMO, then recovered fully. Follow-up MRI at six months showed normal function and resolution of perfusion and enhancement defects. Native T1 mapping showed diffuse myocardial elevation initially, normalizing on recovery.

Keywords

myocarditis

cardiac MRI

subendocardial perfusion defect

ECMO

lymphocytic myocarditis