A case report on myocarditis and right chamber dilation: cardiac magnetic resonance acquisition for accurate diagnosis

Autores de INCLIVA

• 

  Carlos Ángel Bertolín Boronat

  Autor

• Sergio Torondel Calaforra

  Autor

• Enrique Santas Olmeda

  Autor

• 

  Vicent Bodí Peris

  Autor

• 

  Héctor Manuel Merenciano González

  Autor

• Joaquin Gil Romero

  Autor

• 

  Juan Sanchis Fores

  Autor

• 

  Victor Marcos Garcés

  Autor

Participantes ajenos a INCLIVA

• Baettig E

Grupos y Plataformas de I+D+i

• Grupo de Investigación en Cardiología Clínica

  

  Leading Researcher

  Juan Sanchis Fores

• Grupo de Investigación en Insuficiencia Cardiaca

  

  Established Researcher

  Julio Nuñez Villota

• Grupo de Investigación Traslacional en Cardiopatía Isquémica

  

  Leading Researcher

  Vicent Bodí Peris

Abstract

We present the case of a 21-year-old male with chest pain, malaise, and fever, who was initially diagnosed with suspected acute myocarditis. The patient exhibited elevated cardiac troponin levels, occasional premature ventricular complexes, and right ventricular dilation, raising concerns about arrhythmogenic cardiomyopathy. Cardiac magnetic resonance (CMR) imaging showed myocardial edema and subepicardial enhancement in the basal anterolateral segment, confirming myocarditis, but also revealed severe dilation of the right chambers. Advanced imaging sequences identified a previously unrecognized inferior sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return. This finding led to a significant left-to-right shunt and surgical correction was performed. SVASD, a rare congenital anomaly, often remains undiagnosed due to its subtle clinical presentation and limitations of standard imaging techniques. This case highlights the importance of tailored CMR acquisition protocols, which revealed a congenital heart defect in our patient despite an initial focus on myocarditis. The adjustment in diagnostic approach significantly altered the patient's management and may have improved his long-term prognosis.

Keywords

• Myocarditis; sinus venosus atrial septal defect; cardiac magnetic resonance; anomalous pulmonary venous connection; case report