Cardiovascular magnetic resonance in the identification of extra-cardiac causes of myocarditis: a case series

Area of Science:

• Cardiology
• Radiology
• Infectious Diseases

Background:

• Myocarditis diagnosis is complex due to varied presentations.
• Endomyocardial biopsy is invasive; cardiovascular magnetic resonance (CMR) is a key non-invasive alternative.
• Identifying extra-cardiac causes of myocarditis is critical for treatment but often overlooked.

Observation:

• Case 1: CMR identified myocarditis secondary to a liver abscess, resolving after drainage.
• Case 2: CMR revealed myocarditis linked to adult T-cell leukaemia-lymphoma, with poor prognosis due to malignancy.
• Case 3: CMR effectively illustrated myocarditis associated with pneumonia, leading to recovery with antibiotics.

Findings:

• CMR demonstrates significant potential in diagnosing rare extra-cardiac aetiologies of myocarditis.
• Current guidelines lack specific recommendations for CMR in diagnosing extra-cardiac causes.
• Case studies highlight CMR's utility in identifying diverse underlying conditions.

Implications:

• Future guidelines should incorporate CMR's role in diagnosing extra-cardiac myocarditis aetiologies.
• Enhanced diagnostic accuracy through CMR can lead to improved patient outcomes.
• A multidisciplinary approach and further research are recommended for myocarditis diagnosis.