Challenges of Diagnosing Viral Myocarditis in Adolescents in the Era of COVID‐19 and MIS‐C

Figures

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  Figure 1. EKG at initial presentation to adult ED. Sinus rhythm with ST elevations in leads I and aVL, T-wave inversions in the inferior and lateral leads, and prolonged QT interval.

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  Figure 2. Chest X-ray at presentation with PA (a) and lateral (b) views with scattered hazy opacities and no confluent consolidation, pulmonary edema, pleural effusions, or pneumothorax. The cardiac silhouette is within normal limits. Findings are suggestive of an acute inflammatory process.

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  Figure 3. Chest CTA (lung window) at presentation showing multifocal consolidated and ground-glass opacities in the bilateral lungs.

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  Figure 4. Parametric mapping and tissue characterization in myocarditis on cardiac MRI. (a) Short-axis midmyocardial T2 map with normal relaxation time and no evidence of acute edema. (b) Precontrast native midmyocardial T1 map showing diffusely elevated T1 relaxation time specifically along the lateral wall (∗). (c) Midmyocardial extracellular volume (ECV) map indicating increased ECV along the anterior and lateral walls (∗) and the inferoseptal wall (∗∗). (d) Postcontrast pulse sequence inversion recovery image of the midmyocardium with increased pericardial signal (∗∗), evidence of diffuse subepicardial late gadolinium enhancement along the entirety of the lateral wall (∗), and mild pericardial effusion (arrow).