case_images: PMC10858628_01
case_images: EKG showing normal sinus rhythm
case_images: cureus-0016-00000052088-i01.jpg
case_images: PMC10858628_01_cureus-0016-00000052088-i01.jpg
case_images: FIG1
case_images: His EKG showed normal sinus rhythm without any atrioventricular blocks (AV), ventricular tachycardias, and ST-segment elevations (Figure 1). Hypokinesis and attenuated strain along the mid-inferolateral wall were now evident, along with previously reported mid-anterolateral findings (Figure 3, Video 1).
case_images: F-18 FDG metabolic imaging. A: A small area of the mid-anterolateral myocardial wall increased metabolic activity suggesting focal myocardial inflammation. B: T2 sequences demonstrate focal hyperintense signal involving the mid-anterolateral wall. C: Short-axis view showing left ventricular delayed enhancement consistent with scarring/fibrosis involving the transmural mid-anterolateral wall and subendocardial and mid-wall distal anterolateral and mid and distal anterior wall segment. D: Long-axis view. . FDG: Fluorodeoxyglucose
case_images: cureus-0016-00000052088-i02.jpg
case_images: PMC10858628_01_cureus-0016-00000052088-i02.jpg
case_images: FIG2
case_images: The CMR performed during that admission illustrated focal T2 hyperenhancement and delayed hyperenhancement consistent with transmural scarring/fibrosis involving the mid-anterolateral wall and subendocardial fibrosis along to mid to distal anterior wall segments involving the transmural (100% thickness), mid-anterolateral wall, and subendocardial and mid-wall (50% wall thickness) (Figures 2A-2D). Two weeks later, he was in the ambulatory clinic and endorsed the resolution of chest pain, and a follow-up TTE showed a complete resolution of inferolateral wall motion abnormalities but no change in mid-anterior wall hypokinesis (likely focal scarring) consistent with a gratifying response to steroid treatment (Figure 3, Video 2).
case_images: Bullseye plot . A: Mid-inferolateral wall with significantly reduced strain displayed in blue and pink regions. B: Longitudinal strain bullseye plot with complete resolution of the inferior lateral wall after treatment, especially when compared to the strain mapping noted from two weeks earlier, prior to the initiation of corticosteroids demonstrating an excellent response to steroids. No change to the mid-anterior wall was noted, likely due to transmural involvement resulting in scarring.
case_images: cureus-0016-00000052088-i03.jpg
case_images: PMC10858628_01_cureus-0016-00000052088-i03.jpg
case_images: FIG3
case_images: Hypokinesis and attenuated strain along the mid-inferolateral wall were now evident, along with previously reported mid-anterolateral findings (Figure 3, Video 1). Two weeks later, he was in the ambulatory clinic and endorsed the resolution of chest pain, and a follow-up TTE showed a complete resolution of inferolateral wall motion abnormalities but no change in mid-anterior wall hypokinesis (likely focal scarring) consistent with a gratifying response to steroid treatment (Figure 3, Video 2).