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Corresponding author: Dr Zaven Terzian, Department of Cardiology, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France. Tel.: 0140256601; fax: 0140258849.
A 62-year-old male patient was admitted for acute chest pain with elevated levels
of troponin I (4.5 μg/L; normal range, < 0.05 μg/L), and no significant abnormalities
on his electrocardiogram. Transthoracic echocardiographic results were normal. Contrast-enhanced
electrocardiographic gated 64-row multislice computed tomography (CT) showed normal
coronary arteries, and first-pass imaging demonstrated normal myocardial perfusion.
A delayed iodine contrast-enhanced computed tomographic scan using a spectral technique
performed 5 minutes after injection showed a limited subepicardial delayed enhancement
of the inferolateral wall at the mid–left ventricle, suggesting the diagnosis of focal
myocarditis (Fig. 1, A and B). Magnetic resonance imaging (MRI) confirmed the diagnosis of myocarditis
and showed a hypersignal on the T2-weighted sequence and on delayed enhancement consistent
with the edema appearing in acute myocarditis. There was an anatomic match of the
CT and MRI findings (Fig. 1C). The acute phase of the inflammation was affirmed by the edema as seen on the T2-weighted
image. The patient was discharged after clinical improvement and a decrease in troponin
levels and was treated with aspirin for 3 weeks.
Figure 1(A) Five-cavity, 2-cavity, and short-axis views on cardiac computed tomography (CT)
showing normal perfusion of the myocardium. (B) Five-cavity, 2-cavity, and short-axis views on cardiac spectral CT; note the focal
subepicardial delayed enhancement (white arrows) on the iodine mapping imaging, attesting to the increased uptake of iodine contrast
agent in the interstitial tissue of the inflamed myocardium. (C) Five-cavity, 2-cavity, and short-axis views on cardiac magnetic resonance imaging;
confirmed delayed-enhancement findings seen on spectral CT with better contrast but
with an excellent topographic match, involving the subepicardial and intramural delayed
hyperenhancement (white arrows).
