Evaluation of thorax computed tomography findings of patients with COVID-19 associated myocarditis

INTRODUCTION: It is known that human coronaviruses cause myocarditis, and during the pandemic, a series of coronavirus disease (COVID-19) related myocarditis cases have been reported. It is stated that cardiac magnetic resonance (CMR) has a specificity of up to 91% and a sensitivity of 67% for the diagnosis of myocarditis. The present study aims to determine whether patients at risk for myocarditis might be recognized on thoracic CT, comparing thoracic computed tomography (CT) and laboratory findings of patients with COVID-19-associated myocarditis that can be a significant consequence for COVID-19 patients and controls.
METHODS: The study included 51 patients with elevated troponin levels, CMR, and suspected myocarditis to meet this aim. As a result of the evaluation, while myocarditis findings such as a signal change in myocardial contrast involvement on T1 and T2 weighted images and contrast involvement in myocarditis in post-contrast series were detected in 31 patients, no abnormality was detected in the CMRs of 20 patients.
RESULTS: When the thoracic CT findings of the groups were compared, no significant difference was detected in the volumetric evaluations of infiltration frequency, distribution, lateralization, lobar involvement, and lung involvement. No infiltration related to COVID-19 was observed in most of the patients in both groups. Pleural and pericardial effusion were more frequently observed in the group with myocarditis.
DISCUSSION AND CONCLUSION: The present study revealed that myocardial involvement can occur without COVID-19-related distinct lung involvement and that pleural-pericardial effusion can be an alert for myocarditis diagnosis.