CTICasesVaccine-Associated Myocarditis
Imaging findings
Chest CT angiogram shows a benign coronary artery variant where the left anterior descending and left circumflex arteries arise directly from the left coronary cusp. Cardiac MRI performed three days later demonstrates increased T2 signal intensity on stir sequences within the lateral and anterior walls of the left ventricle, indicating myocardial edema. Late gadolinium enhancement (LGE) images show mid-myocardial and subepicardial hyperenhancement predominantly involving the lateral wall, particularly at the base and apex.
Key takeaways
Acute myocarditis can occur in adolescents and young adults shortly after receiving an mRNA-based COVID-19 vaccine, particularly the second dose. The clinical presentation typically features acute chest pain, elevated troponins, and classic non-ischemic, subepicardial, and mid-myocardial late gadolinium enhancement on cardiac MRI. While rare, the condition is usually self-limiting with rapid clinical recovery, and the etiology is believed to be a transient host immune response rather than direct myocardial infection.
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