Immediate cardiac MRI in a 19-year-old revealed lateral wall ischemia due to large marginal branch occlusion from a septic embolism related to endocarditis.
Early cardiac MRI can be pivotal in distinguishing between myocarditis and myocardial infarction in young patients, potentially unveiling rare etiologies like septic embolism.
Abstract Background Myocarditis and myocardial infarction in young patients can present with overlapping symptoms, posing a diagnostic challenge. Advanced cardiac imaging, particularly cardiac MRI, plays a pivotal role in distinguishing between these entities. Case summary A 19-year-old male presented with a 5-week history of fever, general weakness, and new atypical chest pain, raising the suspicion of myocarditis. Immediate cardiac MRI revealed signs of lateral wall ischemia. Coronary angiography confirmed an occlusion of a large marginal branch of the left circumflex artery. Pathological analysis of the retrieved thrombus indicated a septic embolism, and further investigations confirmed endocarditis due to Streptococcus mitis. Discussion This case highlights the essential role of early cardiac MRI in guiding clinical decision-making, particularly in young patients with non-specific symptoms. Although rare, endocarditis-related septic embolism must be considered in the differential diagnosis of acute myocardial infarction in this population.
Nagel et al. (2026) studied this question. Immediate cardiac MRI in a 19-year-old revealed lateral wall ischemia due to large marginal branch occlusion from a septic embolism related to endocarditis.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: