CTICasesAcute Viral Myocarditis with Cardiogenic Shock
Imaging findings
A 42-year-old woman with a history of methadone use and alcohol abuse presented in cardiogenic shock with a new drop in ejection fraction from the 60s to the 30s within a month, requiring mechanical ventilation and pressor support. Cardiac MRI showed global hypokinesis most pronounced along the lateral and inferior walls and septum with relative sparing of the apex, and an extensive, florid amount of mid-myocardial delayed gadolinium enhancement with relative sparing of the endocardium, epicardium, and apex.
Key takeaways
A florid, diffuse mid-myocardial pattern of delayed gadolinium enhancement with apical sparing, in the setting of acute new-onset heart failure and cardiogenic shock, supports a diagnosis of acute myocarditis, presumed viral (such as coxsackievirus or another enterovirus) given the seasonal presentation; chronic alcohol use may have contributed via associated immunosuppression or myocardial dysfunction, and this was described as an unusually extensive degree of enhancement compared with typical myocarditis cases.
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