A 33 year-old female presented with fatigue, dyspnoea, progressive muscle weakness, signs of clinical heart failure and an elevated CK (4113 U/L). Cardiac magnetic resonance (CMR) demonstrated a mildly dilated left ventricle (LV) with severe systolic dysfunction (ejection fraction 28%) and a pericardial effusion (A, Online Video 1). T2-weighted imaging demonstrated normal ratio of myocardial signal intensity relative to skeletal muscle (<2.0) and visually elevated skeletal muscle signal (arrow) (B). Similarly, early myocardial contrast enhanced T1-weighted imaging demonstrated normal (<4.0) myocardial to skeletal muscle ratio (C, D), however absolute myocardial enhancement was 82% (normal <45%) [
]. Late gadolinium imaging demonstrated extensive non-ischaemic circumferential enhancement (arrows) in both long (E) and short axis views (F) with evidence of LV, RV and papillary muscle involvement. Endomyocardial biopsy (G) showed patchy myocyte loss in association with interstitial oedema and fibrosis along with scattered lymphocytes and plasma cells, consistent with acute lymphocytic myocarditis. Skeletal muscle biopsy (H) demonstrated extensive fatty tissue replacement with scattered fascicles of skeletal muscle, within which there was active degeneration and interstitial lymphocytes, both perivascular and surrounding individual myocytes, in keeping with a severe inflammatory myositis (Fig. 1).
- Friedrich M.G.
- Sechtem U.
- Schulz-Menger J.
- Holmvang G.
- Alakija P.
- Cooper L.T.
- et al.
Cardiovascular magnetic resonance in myocarditis: a JACC white paper.
J Am Coll Cardiol. 2009; 53: 1475-1487
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- Cardiovascular magnetic resonance in myocarditis: a JACC white paper.J Am Coll Cardiol. 2009; 53: 1475-1487
Published online: August 19, 2013
Accepted: July 19, 2013
Received: June 1, 2013
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.