Background
Diagnosing cardiovascular injury in COVID patients can be challenging.
Case
Three men aged 67 (case 1), 57 (case 2) and 41 (case 3) years old presented with chest pain and fever. Troponin was positive for case 1 and 3. All were positive for COVID.
Decision-making
Case 1: CT angiography (CTA) chest showed peripheral ground glass lung opacities (Figure A) and calcification of left anterior descending artery (B). ECG showed anterolateral ST depressions which resolved. Cardiac MRI was done which showed mid anterior wall motion abnormality on cine. Delayed enhancement imaging showed subendocardial enhancement of mid anterior wall (C, D). Short axis T2 (E) showed myocardial edema in anterior wall. Findings were consistent with recent myocardial infarction. Coronary angiography 4 weeks later showed 2 vessel disease (F, G). Case 2: Non-contrast chest CT (H) showed hyperdense crescentic eccentrically thickened wall of thoracic aorta consistent with intramural hematoma (IMH). Chest CTA (I) showed Type B dissection from subclavian artery to abdominal aorta. Patient stabilized conservatively. Follow-up axial and sagittal chest CTA (J, K) showed enlarging IMH with new intimal tears. Case 3: Cardiac MRI showed normal ejection fraction. Delayed enhancement imaging showed multifocal mid myocardial enhancement in a non ischemic pattern (L).
Conclusion
Multimodality cardiac imaging can help diagnose cardiovascular injury in patients with COVID 19 while limiting exposure of healthcare workers.
Footnotes
Poster Contributions
Monday, May 17, 2021, 10:45 a.m.-11:30 a.m.
Session Title: Complex Clinical Cases: FIT Multimodality Imaging 3
Abstract Category: FIT: Multimodality Imaging