Transmural LGE on CMR in acute myocarditis may be an uncommon finding that warrants close monitoring for the development of ventricular aneurysms and thromboembolic complications.
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May support vigilance for complications in acute myocarditis with transmural LGE; hypothesis-generating and requires prospective validation.
A 66-year-old female presented with progressive left-sided chest pain. The electrocardiogram (ECG) showed changes typical of an anterior wall myocardial infarction. She immediately underwent coronary angiography which revealed normal coronary arteries. Cardiac MRI (CMR) was then performed, which showed diffuse high intensity on T2-weighted images and transmural late gadolinium enhancement (LGE) in the apical wall. While transmural LGE was not typical for myocarditis, the patient was diagnosed with acute myocarditis based on the clinical and angiographic findings in addition to the high intensity of T2-weighted image. During the course of the disease, the apical wall developed an aneurysm corresponding to the area of transmural LGE on CMR and an intraventricular thrombus formed in the aneurysm. She was given heparin and discharged after resolution of the thrombus. Further evaluation is warranted if this uncommon imaging finding is detected to prevent thromboembolic complications.
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Shiotsuka et al. (2011) studied this question.
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