Unexpected Twist: Large Marginal Branch Occlusion of the LCX Unveiled by Immediate and Pivotal Cardiac MRI in a 19-Year-Old with Suspected Myocarditis – A Case Report

Figures

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  Figure 1. (A and B) Electrocardiogram (25 mm/s, 10 mm/mV) on admission showing subtle changes, including mild ST-segment elevation (∼1 mm) in leads I and aVL, with reciprocal ST-segment depression in the inferior leads. While not diagnostic, these alterations may be consistent with early or subtle ischaemic changes.

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  Figure 2. Cine-SSFP images: (A) four-chamber and (B) short-axis view showing relatively lower signal in the lateral wall (yellow arrows).

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  Figure 3. Gadolinium enhancement images: (A) four chamber early gadolinium enhancement magnitude image as well as late gadolinium enhancement phase sensitive inversion recovery image in the (B) four-chamber and (C) short-axis view showing no contrast uptake in the lateral wall (yellow arrows).

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  Figure 4. Rest perfusion imaging confirming perfusion defect in the lateral wall (yellow arrows).

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  Figure 5. Panels (A)–(H) are shown in chronological order. (A) Coronary angiography of the right coronary artery showing no relevant abnormalities. (B) Occlusion of a large marginal branch of the left circumflex artery (arrow). (C–E) Fragmentation and aspiration of the thrombus; in (E), antegrade perfusion is restored, but a new distal filling defect in the left circumflex artery is visible (arrow). (F–H) Fragmentation and aspiration of the left circumflex artery thrombus are performed; as perfusion could not be fully restored, the affected segment is finally treated with stent implantation (arrow). Note the fractured tip of one of one of the guidewires in (F).