case_images: PMC11342427_01
case_images: Chest X-ray images: increased interstitial thickening and hazy ground glass changes were noted. No pleural effusion or pneumothorax is present.
case_images: 10.1177_2050313X241272551-fig1.jpg
case_images: PMC11342427_01_10.1177_2050313X241272551-fig1.jpg
case_images: fig1-2050313X241272551
case_images: The chest X-ray demonstrated subtle ground glass findings prompting a chest computerized tomography (CT) scan with intravenous (IV) contrast that illustrated the presence of ground glass opacities (GGO) with reactive mediastinal lymphadenopathy, suspected to be related to an infectious process, recent vaccination, and/or secondary to volume overload (Figures 1 and 2).
case_images: Chest CT with IV contrast: axial scans shown with lung and soft tissue windows. Scans illustrate bilateral ground glass opacities (shown with arrows) with mediastinal lymphadenopathy. No pulmonary embolism is noted.. CT: computerized tomography; IV: intravenous.
case_images: 10.1177_2050313X241272551-fig2.jpg
case_images: PMC11342427_01_10.1177_2050313X241272551-fig2.jpg
case_images: fig2-2050313X241272551
case_images: The chest X-ray demonstrated subtle ground glass findings prompting a chest computerized tomography (CT) scan with intravenous (IV) contrast that illustrated the presence of ground glass opacities (GGO) with reactive mediastinal lymphadenopathy, suspected to be related to an infectious process, recent vaccination, and/or secondary to volume overload (Figures 1 and 2).
case_images: Bronchoscopic images: (a) Mucosal edema and friability of right mainstem bronchus. (b) Image of distal bronchus intermedius. (c) Inflamed distal left lower lobe segmental bronchi with evident secretions.
case_images: 10.1177_2050313X241272551-fig3.jpg
case_images: PMC11342427_01_10.1177_2050313X241272551-fig3.jpg
case_images: fig3-2050313X241272551
case_images: A bronchoscopy was subsequently performed and white endobronchial plaques were visualized grossly, as well as copious airway secretions with abnormal, friable mucosa throughout the right and left bronchial trees (Figure 3a-c).
case_images: Cardiac MR images: thickening of myocardium observed on cardiac MRI. LV and RV are mildly dilated in size with severely reduced systolic functions: LVEF measuring at 30.2% and RVEF measuring at 31.2%. LGE of the LV was observed with mid-wall delayed enhancement in the basal inferoseptum, and subendocardial delayed enhancement in the mid-inferoseptum suggesting inflammation and/or necrosis. Moderate pericardial effusion was present as well as elevated T1, T2, and ECV, which was consistent with acute myocarditis. The mitral valve and tricuspid valve demonstrated regurgitation.. ECV: extracellular volume; LGE: late gadolinium enhancement; LV: left ventricle; LVEF: left ventricular ejection fraction; RV: right ventricle; RVEF: right ventricular ejection fraction.
case_images: 10.1177_2050313X241272551-fig4.jpg
case_images: PMC11342427_01_10.1177_2050313X241272551-fig4.jpg
case_images: fig4-2050313X241272551
case_images: Cardiac magnetic resonance imaging (CMR) findings met the Lake-Louise criteria for acute myocarditis with heart failure and a confirmed reduced ejection fraction (Figure 4). In our case, the presence of elevated T2 signals and necrosis satisfy the requirement for Lake-Louise criteria (Figure 4).