Delayed isolated peri-myocarditis in a Covid-19 patient with respiratory symptoms but without lung involvement
- PDF / 665,593 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 95 Downloads / 163 Views
IMAGES IN CV APPLICATIONS
Delayed isolated peri-myocarditis in a Covid-19 patient with respiratory symptoms but without lung involvement Giancarlo Spano1 · Kady Fischer1 · Cédric Maillat2 · Grégory Vicario1,2 · Adrian T. Huber1 · Christoph Gräni1,3 Received: 10 July 2020 / Accepted: 18 July 2020 © The Author(s) 2020
A 49-year-old prior healthy male without any cardiovascular risk factors living in the western part of Switzerland, noted in mid of March 2020 anosmia and dysgeusia, similar to his wife and four people from his close family, with whom he had frequent contact and who were positive for SARS-CoV-2. Six weeks later, he presented to the hospital with new-onset of dyspnea NYHA 3, general weakness, intermittent epigastrical pain and nocturia without orthopnea nor fever. The retro-nasal SARS-CoV-2 PCR, 6 weeks after initial anosmia and dysgeusia was negative but the antibody IgG blood test for SARS-CoV-2 was positive. Computed tomography of the lungs showed no pulmonary embolism, no infiltrates but left heart congestion, suspected by previous thoracic X-ray (A) and pleural effusion (B). Echocardiography revealed diffuse hypokinesia with severely depressed left- and right-ventricular function. The patient showed elevated C-reactive protein, troponin and NT-proBNP. ECG showed dynamic T-wave changes (C) and after ruling out coronary artery disease,
he was diagnosed with isolated peri-myocarditis using multiparametric cardiac magnetic resonance imaging (CMR). CMR showed diffuse thickening of the myocardium and pericardium due to edema confirmed with T2 weighted imaging and T2 mapping (D). Further, pericardial effusion could be seen and tissue characterization revealed diffuse LGE, elevated T1 mapping values and an elevated extracellular volume fraction of 38% (normal value:
Data Loading...
