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. 2011 Feb 24;3(2):e90-e93.
doi: 10.1016/j.jccase.2010.11.003. eCollection 2011 Apr.

Acute inferolateral ST-elevation myopericarditis diagnosed by delayed enhancement cardiac computed tomography

Ricardo Krieger Azzolini  1 , Fernando Arturo Effio Solis  1 , Paulo Cury Rezende  1 , Claudio Campi  1   2 , Henrique Lane Staniak  1 , Rodolfo Sharovsky  1 , Alexandre Volney Villa  2 , Paulo Andrade Lotufo  1 , Márcio Sommer Bittencourt  1
Affiliations

Acute inferolateral ST-elevation myopericarditis diagnosed by delayed enhancement cardiac computed tomography

Ricardo Krieger Azzolini et al. J Cardiol Cases. .

Abstract

A 20-year-old man with no previous medical history presented to the Emergency Department (ED) complaining of 3 h of chest pressure. He denied drug abuse or risk factors for coronary artery disease. He had no symptoms of viral infection. Physical examination was unremarkable. The first electrocardiogram (ECG) showed a 4 mm ST-segment elevation in the inferior leads and no PR depression. His troponin and CK-MB levels were abnormal. Urgent coronary angiography showed no lesions. Echocardiography was normal. The patient was investigated with cardiac computed tomography (CT) and late enhancement imaging. Cardiac anatomy and coronary arteries were normal in the first pass images. Later image acquisition showed an inferolateral enhancement. Since cardiac magnetic resonance (CMR) is the gold standard for myocarditis evaluation, the patient was transferred for CMR evaluation which showed edema and late enhancement in the same myocardial territory diagnosed by CT. The patient was discharged with a diagnosis of myocarditis and presented asymptomatic at 1 month follow-up. This is the first report to show the topographic correlation of the ECG ST elevation with the myocarditis diagnosed by CT and CMR. Since CT is more widely available, its use in myocarditis diagnosis might become part of its routine work up.

Keywords: Cardiac computed tomography; Myocarditis.

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Figures

Figure 1
Figure 1
Electrocardiogram showing significant ST elevation in the inferior leads.
Figure 2
Figure 2
Short-axis views. (A) Cardiac magnetic resonance (CMR) triple-inversion recovery T2-weighted image view showing inferolateral wall edema. (B) CMR delayed enhancement technique showing scattered focal area of subepicardial gadolinium concentration in a similar location. Findings are characteristic of acute myocarditis (arrows). (C) Cardiac computed tomography delayed enhancement with the same pattern of enhancement (arrows).
Figure 3
Figure 3
Four chamber long-axis views. (A) Cardiac magnetic gadolinium delayed enhancement showing subepicardial hyperenhancement (arrow). (B) Cardiac CT delayed enhancement (arrows).
See this image and copyright information in PMC

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