J Korean Med Sci.  2021 Aug;36(32):e229. 10.3346/jkms.2021.36.e229.

Cardiac Imaging of Acute Myocarditis Following COVID-19 mRNA Vaccination

• Kim IC
• Kim H
• Lee HJ
• Kim JY
• Kim JY

• KMID: 2519226
• DOI: http://doi.org/10.3346/jkms.2021.36.e229

Abstract

Increasing rates of coronavirus disease 2019 (COVID-19) vaccination coverage will result in more vaccine-related side effects, including acute myocarditis. In Korea, we present a 24-year-old male with acute myocarditis following COVID-19 vaccination (BNT162b2). His chest pain developed the day after vaccination and cardiac biomarkers were elevated. Echocardiography showed minimal pericardial effusion but normal myocardial contractility. Electrocardiography revealed diffuse ST elevation in lead II, and V2-5. Cardiac magnetic resonance images showed the high signal intensity of T2- short tau inversion recovery image, the high value of T2 mapping sequence, and late gadolinium enhancement in basal inferior and inferolateral wall. It was presumed that COVID-19 mRNA vaccination was probably responsible for acute myocarditis. Clinical course of the patient was favorable and he was discharged without any adverse event.

Keyword

COVID-19; Myocarditis; Vaccination

Figure

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  Fig. 1 Dynamic ST segment changes. At emergency room, diffuse ST segment elevations are shown in leads I, II, aVF, and V2-6 (top). During recovery phase, ST segment elevations begin to be recovered from leads V2-6 (bottom).

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  Fig. 2 Bull's eye map of GLS in echocardiography. At first day of admission, basal inferior wall shows reduced GLS severely from epicardium toward endocardium (top). However, at time of discharge, a reduced GLS was fully recovered (bottom).GLS = global longitudinal strain.

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  Fig. 3 Cardiac magnetic resonance imaging of acute myocarditis. Edema-sensitive T2-short tau inversion recovery shows high signal intensity on basal inferior-inferolateral segment (left). This region is compatible with late gadolinium enhancement (middle). Furthermore, T2 value is elevated up to 51 ms (reference of 40 ms) on same region on T2 map (right).

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