Imaging in COVID-19-related myocardial injury

Fig. 1. Diagnostic pathway for suspected myocarditis

Fig. 2. A 27-year-old patient, without any significant past medical history, was admitted to our hospital with fever and chest pain. The onset of symptomatology dated back about 1 week. His initial investigation showed elevated troponin levels at laboratory tests. Electrocardiography displayed ST-segment elevation. Viral myocarditis of unknown aetiology was initially suspected, but SARS-Co-V-2 as a cause was ruled out later at serology. Echocardiography was normal. A chest X-ray showed pulmonary consolidation at the left lower lobe. Cardiac magnetic resonance imaging confirmed the myocarditis (panel a). T2 STIR (panel b) showed an increased signal in mid-basal inferior and inferior-lateral segments. The analysis of T1 mapping (panel c) showed an increase in signal at the same segments (average values of 1100 ms, with reference values of 1030 ± 30 ms). T2 mapping values (panel d) showed an increased signal in mid-basal inferolateral segment (65 ms. Reference values: 52 ± 3 ms), thus indicating the presence of edema. In the sequences acquired later after contrast, an area of sub-epicardial LGE in mid-basal inferior and infero-lateral segments was observed with a concomitant involvement of…

Fig. 3. A 37-year-old male patient, without any significant past medical history, was admitted to our hospital with oppressive chest pain, sweating, severe fatigue. At the swab was positive for COVID19. Sublingual nitroglycerin showed no clinical benefits with alterations in the LV Sax TIR T2 sequences (a–c) with patchy alterations in the LAx MDE sequences (d–f white arrows). Also the native T1 mapping showed an area of alteration (white arrow) with areas of hypersignal in the SAx MDE sequences (k–m). The T2 map shows in the same region of the T1 map area of alteration (n–p white arrow). The q–s panels show the ECV. Courtesy of Professor Gianluca Pontone MD—Centro Cardiologico Monzino (Milano)