Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
J Cardiovasc Comput Tomogr. 2009 Nov-Dec;3(6):409-11. doi: 10.1016/j.jcct.2009.09.003. Epub 2009 Sep 24.
A healthy 19-year-old man with no history of substance abuse presented with 3 days of dyspnea and chest pressure relieved by leaning forward associated with nausea, emesis, and diarrhea. Cardiac computed tomography angiography (CCTA) showed normal coronary artery anatomy and no evidence of coronary artery plaque. The delayed-enhancement CCTA showed patchy epicardial and mid-myocardial enhancement of the wall and apex, consistent with myocardial inflammation. Delayed-enhancement cardiac magnetic resonance imaging (CMR) performed the following day confirmed patchy, diffuse epicardial hyperenhancement of the lateral wall, septum, and apex consistent with myocardial inflammation. Both CCTA and CMR supported the diagnosis of acute myocarditis. Delayed-enhancement CCTA is correlated with delayed-enhancement CMR in acute myocarditis by territory and extent and can show late hyperenhancement that can be transmural, subepicardial, or confined to small foci within a layer of the myocardium. Delayed-enhancement CCTA has potential utility for simultaneous evaluation of coronary arteries and myocardial inflammation in suspected myocarditis.
一位 19 岁健康男性，无药物滥用史，诉 3 天来呼吸困难，胸部压迫感，前倾时缓解，伴有恶心、呕吐和腹泻。心脏计算机断层扫描血管造影（CCTA）显示正常冠状动脉解剖结构，无冠状动脉斑块证据。延迟增强 CCTA 显示心外膜和心肌中层壁和心尖的斑片状增强，符合心肌炎症。次日进行的延迟增强心脏磁共振成像（CMR）证实了侧壁、室间隔和心尖的斑片状、弥漫性心外膜高增强，符合心肌炎症。CCTA 和 CMR 均支持急性心肌炎的诊断。延迟增强 CCTA 通过区域和范围与急性心肌炎的延迟增强 CMR 相关，并可显示晚期高增强，可透壁、心外膜下或局限于心肌某一层内的小病灶。延迟增强 CCTA 在疑似心肌炎中具有同时评估冠状动脉和心肌炎症的潜在用途。
