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A 17-year-old boy with chest pain and transient ventricular wall thickening

Part of: Echocardiography

Published online by Cambridge University Press:  24 March 2022

Habib A. Dakik Open the ORCID record for Habib A. Dakik [Opens in a new window]
Habib A. Dakik*
Affiliation:
Department of Medicine, American University of Beirut, Beirut, Lebanon
*
Author for correspondence: H. A. Dakik, MD, FACC, Professor of Medicine, Chief of Cardiology, American University of Beirut, P.O.Box 11-0236 / A38, Beirut, Lebanon. Tel: +9613297084. E-mail: hd01@aub.edu.lb
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Abstract

We describe the case of a 17-year-old boy who developed acute myopericarditis associated with transient ventricular wall thickening. This is a unique teaching case illustrating that acute myocarditis can be associated with significant oedema, secondary to inflammation, causing marked wall thickening that is apparent on echocardiography. This oedema resolves completely with anti-inflammatory drug treatment.

Keywords

Myocarditismyocardial oedema

Information

Type
Brief Report
Information
Cardiology in the Young , Volume 32 , Issue 11 , November 2022 , pp. 1862 - 1863
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

A 17-year-old boy complained of pleuritic chest pain exacerbated by movement and deep inspiration, 1 week after having an upper respiratory tract infection. On physical exam, he was noted to have a friction rub over the precordium. His ECG showed T wave inversion in leads I, II, AVF, V5, V6, and high peaked T waves in leads V1–V3 (Fig 1). Blood tests were ordered and showed elevated troponin T (0.1 ng/ml, normal upper limit 0.03 ng/ml) and CRP (40 mg/L) levels. Echocardiography was performed and showed thickening (1.7 mm) and hypokinesis of the posterolateral wall with a mild circumferential pericardial effusion (Fig 2). His left ventricular ejection fraction remained preserved at >50%. The patient was diagnosed to have myopericarditis and treated with indomethacin and colchicine. His symptoms resolved after 15 days. Repeat echocardiography done 2 months later showed normal posterolateral wall thickness and function (Fig 3).

Figure 1.

ECG on presentation showing T wave inversion in leads I, II, AVF, V5, V6, and high peaked T waves in leads V1–V3.

Figure 2.

Echocardiographic image on presentation of the left ventricular base in the parasternal short-axis plane showing thickening of the posterolateral (PL) wall (red arrows). PS = Pericardial space.

Figure 3.

Echocardiographic image after 2 months of treatment showing resolution of the myocardial oedema with a normal thickness of the posterolateral (PL) wall (red arrows).

Acute myocarditis is associated with myocardial oedema secondary to inflammation which usually requires MRI for detection. Reference Cooper1–Reference Tschöpe, Ammirati, Bozkurt, Caforio, Cooper and Felix3 This case is unique in that the inflammation and myocardial oedema were very prominent causing significant ventricular wall thickening that was apparent on echocardiography and which resolved after treatment with non-steroidal anti-inflammatory drugs.

Acknowledgements

None.

Financial support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Conflicts of interest

None.

Consent

The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance.

References

Cooper, LT. Myocarditis. N Engl J Med 2009; 360: 1526–1538.CrossRefGoogle ScholarPubMed
Ferreira, VM, Schulz-Menger, J, Holmvang, G, et al. Cardiovascular magnetic resonance imaging in nonischemic myocardial infalmmation. J Am Coll Cardiol 2018; 72: 3158–3176.CrossRefGoogle Scholar
Tschöpe, C, Ammirati, E, Bozkurt, B, Caforio, ALP, Cooper, LT, Felix, SB. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 2021; 18: 169–193.CrossRefGoogle ScholarPubMed
Figure 0

Figure 1. ECG on presentation showing T wave inversion in leads I, II, AVF, V5, V6, and high peaked T waves in leads V1–V3.

Figure 1

Figure 2. Echocardiographic image on presentation of the left ventricular base in the parasternal short-axis plane showing thickening of the posterolateral (PL) wall (red arrows). PS = Pericardial space.

Figure 2

Figure 3. Echocardiographic image after 2 months of treatment showing resolution of the myocardial oedema with a normal thickness of the posterolateral (PL) wall (red arrows).