Evaluation of myocarditis with delayed-enhancement computed tomography

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.