Native T1 Mapping Demonstrating Apical Thrombi in Eosinophilic Myocarditis Associated with Churg-Strauss Syndrome

Abstract

Eosinophilic myocarditis is a disease characterized by eosinophilic infiltration of the myocardium, consisting of acute necrotic stage, thrombotic stage, and fibrotic stage. Although T1 mapping has been increasingly used in various cardiac pathologies, there has been no report of T1 mapping in eosinophilic myocarditis. We report a case of 75-year-old female with eosinophilic myocarditis, whose cardiac magnetic resonance imaging included native T1 mapping, in which apical thrombi were distinctly seen as areas with decreased T1 values, next to areas of inflammation seen as increased T1 value in subendocardium.

Utility of cardiac magnetic resonance imaging in diagnosing eosinophilic myocarditis in a patient recently recovered from COVID-19: a grand round case report

“… 13 Eosinophilic myocarditis, more specifically, tends to follow a patchy or diffuse non-ischaemic sub-endocardial pattern of LGE but can also less frequently demonstrate mid-wall and subepicardial LGE. 2 , 14 , 15 The presence of intra-cardiac thrombi is also associated with eosinophilic heart disease. 14 Corticosteroids are the mainstay of treatment for EM, and therapy is further tailored based on the underlying cause.…”

“…However, in the acute setting, T1 and ECV fraction along with T2 values is often increased in both EM and COVID-related myocardial injury, and thus cannot reliably differentiate the two. 15 , 19 The presence of oedema in EM also depends on the phase of the disease, and as such, the pattern of LGE distribution is important. LGE is an overall less prevalent finding on CMRI in COVID-19 myocarditis compared to EM; when present, it is more frequently seen in the mid-ventricular region and with a non-ischaemic subepicardial pattern ( Figure 6C ).…”