Korean Circ J.  2016 Nov;46(6):882-885. 10.4070/kcj.2016.46.6.882.

Native T1 Mapping Demonstrating Apical Thrombi in Eosinophilic Myocarditis Associated with Churg-Strauss Syndrome

• Beck KS
• Jeong SY
• Lee KY
• Chang K
• Jung JI

• KMID: 2355469
• DOI: http://doi.org/10.4070/kcj.2016.46.6.882

Abstract

Eosinophilic myocarditis is a disease characterized by eosinophilic infiltration of the myocardium, consisting of acute necrotic stage, thrombotic stage, and fibrotic stage. Although T1 mapping has been increasingly used in various cardiac pathologies, there has been no report of T1 mapping in eosinophilic myocarditis. We report a case of 75-year-old female with eosinophilic myocarditis, whose cardiac magnetic resonance imaging included native T1 mapping, in which apical thrombi were distinctly seen as areas with decreased T1 values, next to areas of inflammation seen as increased T1 value in subendocardium.

Keyword

Myocarditis; Necrosis; Thrombosis; Churg-Strauss syndrome; Magnetic resonance imaging

MeSH Terms

Aged
Churg-Strauss Syndrome*
Eosinophils*
Female
Humans
Inflammation
Magnetic Resonance Imaging
Myocarditis*
Myocardium
Necrosis
Pathology
Thrombosis

Figure

• 

  Fig. 1 Eosinophilic myocarditis associated with Churg-Strauss syndrome in a 75-year-old woman. (A) Apical four-chamber view of the heart on echocardiogram shows hypertrophied left ventricular apex with impaired relaxation. (B) T2-weighted image of the heart, short axis view demonstrates multifocal, patchy high signal intensity lesions (arrows) throughout the left ventricular wall, suggesting areas of edema. (C, D) Late Gadolinium enhancement (LGE) images in four-chamber view (C) and short axis view (D) demonstrate diffuse subendocardial enhancement in the left ventricular wall with non-enhancing thrombi (arrows) in the apex. (E) Cardiac MR mapping images of the heart. T1 mapping of the apex demonstrates oval areas (black arrows) with decreased T1 value (1007±84.67 ms), which correspond to the mural thrombi seen on LGE images. T1 value of subendocardium immediately adjacent to the mural thrombi (white arrows) are diffusely increased (1527±67.41 ms), corresponding to areas that show subendocardial enhancement on LGE images (reference value: 1278±30 ms). (F) Myocardial biopsy specimen shows infiltration of eosinophils (arrows) in the myocardium, confirming the diagnosis of eosinophilic myocarditis (H-E, x400).

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