CTICasesCannabis-Associated Myocarditis
Imaging findings
Cardiac MRI in a young male patient presenting with recurrent chest pain, elevated troponin levels, and a positive urine drug screen (UDS) for tetrahydrocannabinol (THC) demonstrates patchy, mid-myocardial late gadolinium enhancement (LGE) on delayed post-contrast imaging, consistent with acute myocardial injury/myocarditis. Left ventricular ejection fraction was mildly reduced on the initial scan but showed improvement on a six-month follow-up study, which also demonstrated a slight increase in the area of LGE. Coronary angiography was completely normal.
Key takeaways
Cannabis and synthetic cannabinoid use have been increasingly linked to acute cardiovascular events in young patients, including stress-induced (Takotsubo) cardiomyopathy and acute myocarditis. Cardiac MRI plays a key role in the non-invasive diagnosis of myocarditis by demonstrating mid-myocardial or subepicardial late gadolinium enhancement (LGE), which typically spares the subendocardium, helping to differentiate it from ischemic injury.
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