PMC8488501_01
Left: Initial 12-channel ECG of our patient with ST elevations in I, II, aVF, andV2-V6 as well as ST depression in aVR. Right: Transthoracic echocardiography showing the transmitral inflow profile (pulsed wave Doppler) with significant respiratory variance as a sign of hemodynamic relevance of pericardial effusion.
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A 12-lead electrocardiogram (ECG) demonstrated ST elevations in I, II, aVF, and V2-V6 as well as ST depression in aVR (Figure 1 left). Transthoracic echocardiography demonstrated reduced systolic global function with a significantly reduced longitudinal shortening (lateral and anterior) and a circular pericardial effusion (10 mm end diastolic), resulting in a hemodynamic compromise (Figure 1 right), matching the aforementioned clinical presentation.
Cardiac MRI: late gadolinium enhancement (LGE) in four-chamber view and short-axis view (SAX). T1 relaxation times as color-coded maps (T1maps) in SAX.. Pericardial effusion (blue asterisk) and pericardial LGE (red arrow) indicating pericarditis (a; 2018/08). Increased pericardial thickening and LGE with decrease in pericardial effusion (b; 2019/01). Absent myocardial LGE and normal relaxation times in T1maps, so there are no more signs of previous myocardial involvement. Note the left-sided pleural effusion.
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AST and ALT values were nearly normalized and CRP levels were markedly diminished. A follow-up MRI scan of the heart 1 week later, which was done due to recurrent thoracic pain and tachycardia, described progressive pericarditis with new onset of inflammation in the myocardial tissue (Figure 2, row a). However, MRI morphological signs of improvement could be detected, represented by a decrease in pericardial effusion and resolved myocardial affection (Figure 2, row b).