Cardiac magnetic resonance: One slice, two different LGE patterns

A 56-years-old man with previous myopericarditis (10 months earlier, coronary angiography not performed) was admitted because of pericarditis pain and ST segment elevation, together with myocardial necrosis markers rise. Electrocardiogram (EKG) showed negative T waves in lateral and inferior leads; echocardiogram showed mild pericardial effusion and inferior and lateral basal hypokinesis. Cardiac magnetic resonance imaging (CMRI) on day 7 post-admission showed increased T2-short tau inversion recovery (T2-STIR) signal of inferior wall and two different noncontiguous late gadolinium enhancement (LGE) areas: Ischemic-like with about 75% transmural extension (inferior wall) and subepicardial (inferolateral wall) along with pericardial LGE (inferior and inferolateral wall). Coronary angiography showed three vessel disease. Pathogenetic hypothesis of these unexpected findings are discussed. This case shows again the ability of CMRI to unreveal unusual and unexpected pathologic patterns.