How does a patient with myocarditis present clinically and what are the findings on MRI?
Myocarditis has been reported in up to 12% of young adults presenting with sudden death. MRI is indicated in patients with current or persistent symptoms, evidence for significant myocardial injury, and a suspected viral etiology. MRI is of potential use in patients with chest pain, elevated troponin levels, and normal coronary arteries, where it can identify myocarditis in more than 30% of patients. Findings on MRI include increased myocardial signal intensity on T2-weighted images resulting from intracellular and interstitial edema, arterial phase enhancement from hyperemia and capillary leak, and LGE from fibrosis.