Background Acute myocarditis is one of the causes of acute non-ischemic myocardial injury mimicking acute coronary syndrome (ACS) on presentation. It is usually underdiagnosed due to the non-specificity of presenting symptoms, elevated troponin levels, and abnormal ECG (electrocardiogram) findings. Delayed contrast-enhanced cardiac MRI (CMR) is known as the gold standard imaging modality for differentiating acute non-ischemic myocardial injury from infarcted myocardium. The most frequent cause of myocarditis is viral infections, but further infrequent causes include other infectious pathogens, toxins, hypersensitivity drug reactions, and autoimmune diseases. Cannabis is one of the most abused illicit and recreational drugs in the world among adolescents and adults. Also, many reports of marijuana-associated cardiovascular risks have been established previously, mainly presenting as arrhythmias, myocardial infarction, and myocarditis. Case presentation A 19-year-old female, complaining of radiating chest pain to the left arm and jaw, along with associated sweating for 1 day. Initial work-up showed elevated troponin levels with ST segment elevation on ECG. On further investigation, CMR showed findings of myocarditis and negative virology work-up led to a work-up of proper history, which revealed marijuana abuse, with a history of consumption 3 days before presentation. Hence, it was diagnosed as toxic myocarditis secondary to presumed cannabis abuse and treated for same. Conclusions Non-ischemic myocardial injury causes like myocarditis should be considered in young patients especially, who are presenting to emergency with ACS. CMR should be used as a first line diagnostic imaging modality (based on its availability) in cases mimicking an ACS or suspected myocarditis, especially in young patients. Though viral etiology is considered the most common cause of myocarditis, less common causes such as toxic myocarditis must be considered in cases of young individuals presenting with ACS in an emergency.

PurposeTo assess the utility of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) maps and T2* mapping in quantitative analysis of nucleus pulposus (NP) and annulus fibrosus (AF) of lumbar intervertebral discs with its correlation with modified Pfirrmann grading (MPG) for lumbar degenerative disc disease (LDDD).Material and methodsOne hundred subjects (20-74 years of age) underwent T2-weighted, DWI with ADC and T2* magnetic resonance imaging. MPG was applied to L3-L4, L4-L5, and L5-S1 discs, and ADC and T2* values of NP and AF were calculated in the mid-sagittal plane by segmenting each disc into 5 regions of interest (ROI) (NP-3, AF-2). Mean ADC and T2* values, their correlation, and cut-offs among different grades were calculated at different ROIs across different levels.ResultsOut of total 300 discs analysed; 68 were normal (grade I) discs and 232 were degenerated (grade II to VIII) discs, based on MPG. T2* and ADC values in NP, AF, and the entire disc were significantly lower in degenerated discs than in normal discs. There was significant (p < 0.001) negative correlation between ADC and T2* values with MPG. ADC and T2* cut-off values were statistically significant across grades, with area under the curve (AUC) values in moderate to high accuracy range (0.8 to > 0.9) for assessing the degree of LDDD.ConclusionsT2* and ADC value-based grade scales are highly accurate in evaluating the degree of disc degeneration with a high degree of objectivity in comparison to visual assessment-based MPG. Reduced ADC and T2* values of NP could serve as markers of early LDDD.