Delayed contrast enhancement in a patient with perimyocarditis on contrast-enhanced cardiac MRI: case report

Abstract

The findings of contrast-enhanced cardiac magnetic resonance imaging of a 19-year-old man with perimyocarditis in the subacute and chronic stage are presented. In perimyocarditis., it is useful to check the presence of delayed contrast enhancement to confirm the presence of the lesion and to evaluate the severity of inflammation in the acute stage as well as to determine the extent of fibrosis in the pericardium and myocardium in the chronic stage.

A Case of Acute Myocarditis with Evaluation of Magnetic Resonance Imaging

“…In the early phase (first week) intramural subendocardial patchy nodular enhancement is typical. After the second week (late phase) diffuse enhancement may be seen [5,11]. In a large series recently published the most common sight of involvement was the lateral wall of the left ventricle.…”

Perimyocarditis

“…In perimyocarditis, gadolinium contrast MRI is useful to confirm the diagnosis by detecting an area of delayed contrast-enhancement, to evaluate the severity of inflammation in the acute stage as well as to determine the extent of fibrosis in the pericardium and myocardium [42]. The normal pericardium is observed as an area of low intensity on T1-weighted images and T2-weighted images [43].…”

“…The normal pericardium is observed as an area of low intensity on T1-weighted images and T2-weighted images [43]. In acute pericarditis, the inflamed pericardium is thickened and appears as an area of medium to high intensity with delayed contrast-enhancement recognized in the swollen pericardium which extends to the subepicardial myocardium affected by myocarditis [42]. The delayed enhancement in cardiac magnetic resonance (CMR) is explained by the leaking of the contrast media into the interstitial space due to inflammation.…”