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• W3204407633 abstract "HomeRadiology: Cardiothoracic ImagingVol. 3, No. 5 PreviousNext Images in Cardiothoracic ImagingFree AccessCardiac MRILate Gadolinium Enhancement after COVID-19 VaccinationHunter Wilson, Mark D. Norris, Olivia Frosch, Prachi P. Agarwal Hunter Wilson, Mark D. Norris, Olivia Frosch, Prachi P. Agarwal Author AffiliationsFrom the Division of Pediatric Cardiology, Department of Pediatrics (H.W., M.D.N., O.F.), Department of Radiology (H.W., P.P.A.), and Department of Internal Medicine (M.D.N.), C.S. Mott Children’s Hospital, University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.Address correspondence to P.P.A. (e-mail: [email protected]).Hunter WilsonMark D. NorrisOlivia FroschPrachi P. Agarwal Published Online:Sep 30 2021https://doi.org/10.1148/ryct.2021210199MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A previously healthy 16-year-old female patient experienced chest pain 2 days after the second dose of the Pfizer-BioNTech COVID-19 vaccine. Workup revealed elevated high-sensitivity cardiac troponin T level and electrocardiographic abnormalities, prompting hospitalization with diagnosis of myocarditis. Peak high-sensitivity cardiac troponin T level was 3492 pg/mL (reference range, 0–19 pg/mL); three echocardiograms were normal. Nonsteroidal anti-inflammatory drug therapy resulted in symptomatic improvement. Cardiac MRI performed 6 weeks after hospitalization revealed normal biventricular function and no myocardial edema. Late gadolinium enhancement (LGE) imaging showed subepicardial LGE of the basal inferolateral and inferior walls extending to the midventricular anterolateral, inferolateral, and inferior walls and apical lateral wall (Figure). Recent reports raise concern for acute myocarditis following COVID-19 vaccination (1–3); however, definite proof about the direct link between COVID-19 vaccine and myocarditis is still pending. Although long-term implications are unclear, the extensive LGE in this case seen well past resolution of acute symptoms raises concern for ventricular arrhythmia, future diastolic dysfunction, and other sequelae. Further evaluation of patients after symptomatic recovery should be considered given unknown natural history.Images in a 16-year-old female patient with chest pain 2 days after the second dose of COVID-19 vaccine and with a peak high-sensitivity cardiac troponin T level of 3492 pg/mL who underwent cardiac MRI 6 weeks after hospitalization. (A) Black-blood T2-weighted MR image in short-axis view shows no hyperintense signal to suggest myocardial edema. (B–D) Phase-sensitive inversion-recovery late gadolinium enhancement (LGE) MR images in (B) four-chamber and (C, D) short-axis planes show prominent subepicardial LGE involving more than 50% of the myocardium in the basal inferolateral and inferior segments of the left ventricle (arrows, C) and in the anterolateral (arrows, B and D), inferolateral, and inferior segments of the left ventricle at the midventricular level (arrows, D).Download as PowerPointDisclosures of Conflicts of Interest: H.W. No relevant relationships. M.D.N. No relevant relationships. O.F. No relevant relationships. P.P.A. Clinical Study Agreement MYK-461-005: A Randomized, Double-blind, Placebo-controlled Clinical Study to Evaluate Mavacamten (MYK-461) in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy MyoKardia, Inc.-18- PAF06025 Co-I with Effort (Principal Investigator: Sara Saberi) 06/2018-03/2022; SPIROMICS II Heart Failure Substudy SubK-NIH-DHHS-US through a consortium with Columbia University- 19- PAF02625 Co-I with Effort (Principal Investigator: Meilan K Han) 06/2023; Editor-in-chief for Seminars in Roentgenology; editorial board member for Radiology: Cardiothoracic Imaging.AcknowledgmentThe authors acknowledge the contributions made by Jimmy Lu to help prepare this work.Keywords: Pediatrics, MR-Imaging, Cardiac, HeartAuthors declared no funding for this work.References1. Marshall M, Ferguson ID, Lewis P, et al. Symptomatic Acute Myocarditis in 7 Adolescents After Pfizer-BioNTech COVID-19 Vaccination. Pediatrics 2021;148(3):e2021052478. Crossref, Medline, Google Scholar2. Rosner CM, Genovese L, Tehrani BN, et al. Myocarditis Temporally Associated With COVID-19 Vaccination. Circulation 2021;144(6):502–505. Crossref, Medline, Google Scholar3. Mansour J, Short RG, Bhalla S, et al. Acute myocarditis after a second dose of the mRNA COVID-19 vaccine: a report of two cases. Clin Imaging 2021;78(247):249. Google ScholarArticle HistoryReceived: July 10 2021Revision requested: Aug 16 2021Revision received: Aug 30 2021Accepted: Sept 17 2021Published online: Sept 30 2021 FiguresReferencesRelatedDetailsCited ByMyocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 StudiesPedramKeshavarz, FereshtehYazdanpanah, MaryamEmad, AzadehHajati, Seyed FarazNejati, FaranakEbrahimian Sadabad, TamtaAzrumelashvili, MalkhazMizandari, Steven S.Raman2022 | Tomography, Vol. 8, No. 4Recommended Articles Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 VaccinationRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 6MRI Findings in Desmoplakin-related Arrhythmogenic Left Ventricular Cardiomyopathy in a Pediatric Patient: A Case ReportRadiology: Cardiothoracic Imaging2023Volume: 5Issue: 2Myocardial Inflammation at FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 VaccinationRadiology: Cardiothoracic Imaging2023Volume: 5Issue: 2Imaging Acute and Chronic Cardiac Complications of COVID-19 and after COVID-19 VaccinationRadioGraphics2023Volume: 43Issue: 9Cardiac MRI in Patients with Acute Chest PainRadioGraphics2020Volume: 41Issue: 1pp. 8-31See More RSNA Education Exhibits Myocarditis 2.0: The Ultimate Guide for RadiologistsDigital Posters2020Coronary CT Angiography with Myocardial Late Enhancement Protocol in the Emergency Room: Tips and TricksDigital Posters2022Incidental Focal FDG Uptake in the Left Ventricle on Oncologic FDG-PET/CT: Be Careful with the FDG Uptake in the Left VentricleDigital Posters2019 RSNA Case Collection Chronic myocardial infarctionRSNA Case Collection2020Acute myocardial InfarctionRSNA Case Collection2021Hypertrophic cardiomyopathyRSNA Case Collection2020 Vol. 3, No. 5 Metrics Altmetric Score Open AccessThis article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.PDF download" @default.
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