A Case Series Examining the 1-year Follow-up Outcomes of Myocarditis Associated with COVID-19 Vaccination

Figures

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  Figure 1. Comparing the first set of images (top row) to the follow-up scan (bottom row) after 10 months of diagnosis. There is evident clearing of the basal and mid-inferolateral wall edema (T2 weighted image) and hyperemia (early enhancement) with a minimal residual scar in the same region as seen in the late gadolinium sequences (late gadolinium enhancement) as represented by the white arrows. T2 WI: T2 weighted image, EE: Early enhancement, LGE: Late gadolinium enhancement

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  Figure 2. Short-axis views comparing the first set of images to the follow-up scan after 15 months of diagnosis. There is a total resolution of the mid-anterior wall edema (T2 weighted image) yet with a minimal residual scar in the mid-to-apical infernolateral walls as seen in the late gadolinium sequences (late gadolinium enhancement) as represented by the white arrows. T2 WI: T2 weighted image, LGE: Late gadolinium enhancement

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  Figure 3. Comparing the initial diagnostic images (top row) to the follow-up scan (bottom row) after 10 months showing resolution of the mid-anterolateral wall edema (T2 weighted image) and hyperemia (early enhancement) yet with faint residual fibrosis at the mid-to-apical inferolateral and lateral walls (short axis and four chambers (late gadolinium enhancement) as represented by the white arrows. T2 WI: T2 weighted image, EE: Early enhancement, LGE: Late gadolinium enhancement

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  Figure 4. After 6 months of initial diagnosis (top row) the follow-up scan (bottom row) showed complete regression of the focal mid-lateral wall edema (T2 weighted image) and and hyperemia (early enhancement). Only subtle focal lateral wall fibrosis remains, as seen in the late gadolinium bright blood and black blood images (late gadolinium enhancement) as represented by the white arrows. T2 WI: T2 weighted image, EE: Early enhancement, LGE: Late gadolinium enhancement

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  Case no. 1. (a) Electrocardiogram: Sinus bradycardia at rate 55/min and with nonspecific ST-T changes. (b) Chest X-ray: Normal size cardiac shadow and prominent bronchovascular markings bilaterally. (c) Computed tomography coronary angiography (no coronary artery disease or anomalies). Three-dimensional volume rendering technique of coronary tree. (d) T2 weighted short-tau inversion recovery cardiac magnetic resonance imaging (CMR) short-axis images at the mid-cavity level showing subtle anteroseptal, anterior, and inferior wall edema (arrows). (e) Early gadolinium enhancement CMR short-axis images at mid-cavity level showing lateral and inferior wall myocardial hyperemia (arrows). (f and g) Late gadolinium CMR short-axis acquisition showing basal subepicardial anterior, anterolateral, and inferior wall necrosis (f) and mid-cavity level lateral subepicardial enhancement (arrow)

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  Case no. 2. (a) Electrocardiogram: Diffuse concave upward ST segment elevation in lead I, II, aVL, V2–V6, ST depression in aVR, and lead III. (b) Chest X-ray: Normal size cardiac shadow and lung fields. (c) Computed tomography coronary angiography showed no significant coronary artery disease or coronary anomalies. Three-dimensional volume rendering technique of coronary tree. (d) T2 weighted short-tau inversion recovery cardiac magnetic resonance imaging (CMR) short-axis images at the basal level showing anterior and lateral wall edema (arrows). (e) Late gadolinium CMR short-axis images at mid-cavity level showing anterior and lateral wall subepicardial enhancement (arrows). (f) Late gadolinium CMR four-chamber images showing extensive basal to apical lateral wall subepicardial enhancement (arrows)

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  Case no. 3. (a) Electrocardiogram: Normal sinus rhythm with no ST-T segment abnormalities. (b) Chest X-ray: Normal size cardiac shadow and slightly prominent bronchovascular markings on the right. (c) Computed tomography coronary angiography (no coronary artery disease or anomalies). Three-dimensional volume rendering technique of coronary tree. (d) T2 weighted short-tau inversion recovery short-axis images at the basal level showing subtle anterior wall edema (arrow). (e) Late gadolinium enhancement cardiac magnetic resonance imaging short-axis acquisition showing basal level subepicardial to mid-wall inferior and inferolateral necrosis (arrow)

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  Case no. 4. (a) Electrocardiogram: ST-segment elevation in II, III, aVF, V4–V6, ST depression with T inversion in V1. (b) Chest X-ray: Normal size cardiac shadow and lung window. (c) T2 weighted short-tau inversion recovery cardiac magnetic resonance imaging (CMR) short-axis images at the mid-cavity level showing anterior and anterolateral wall edema (arrows). (d) Early gadolinium enhancement CMR short-axis images at mid-cavity level showing lateral wall myocardial hyperemia. (e) Late gadolinium CMR short-axis acquisition showing mid-cavity level subepicardial lateral and inferior wall enhancement (arrows) and evidence of minimal circumferential pericardial effusion. (f) Late gadolinium CMR four-chamber view showing subepicardial lateral wall enhancement (arrow)

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  Case no. 5. (a) Electrocardiogram: Normal sinus rhythm with no ST-T segment abnormalities. (b) Chest X-ray: Normal size cardiac shadow and lung fields. (c) Coronary angiography showing no coronary artery disease. (d) short-tau inversion recovery T2 weighted short-axis showing subtle focal mid-lateral wall edema (arrow). (e) Short-axis early gadolinium enhancement showing faint mid-lateral wall focal subepicardial hyperemia (arrow). (f) Short-axis Phase-sensitive inversion recovery (PSIR) late gadolinium sequence showing focal lateral wall myocardial enhancement (arrow). (g) Short-axis late gadolinium black blood sequence showing focal lateral wall myocardial enhancement (arrow)