Coronavirus (COVID-19)

Left, a 3-D rendering of a heart from a cardiac CT exam. Right, a lung-CT exam showing the heart and ground glass lesions in the lungs of a COVID-19 patient. CT has become a front-line imaging modality in the COVID era because it offers both cardiac and lung information to help determine a patients disposition with chest pain, COVID-19 and COVID-caused myocarditis and pulmonary embolism.

Figure B — Top panel, neutrophils noted in collections within small vessels (blue arrow), plump endothelial cells (yellow arrowhead) and a single perivascular dying myocyte (blue arrowhead). Bottom panel, single myocyte undergoing degeneration (blue arrowhead) and plump endothelial cell (yellow arrowhead). Figure C — Electron microscopy, showing particles of SARS-CoV-2 virus present within a cardiac endothelial cell (blue arrowheads), but not present in neighboring cardiac myocyte (left side of image). Images from Circulation.

Cardiac MRI for four children with clinical diagnosis of acute myocarditis in the setting of COVID-19–related Kawasaki-like symptoms of MIS-C. The top panel demonstrates minimal pericardial effusion on cine images. The second panel demonstrates increased T2-STIR signal intensity with average ratios between myocardium and muscle > 2 in patient 2 (12-year-old male), patient 3 (11-year-old female) and patient 4 (6-year-old female). The third panel demonstrates abnormal native-T1 mapping, which was > 1,100 ms in patients 2, 3 and 4 and normal in patient 1 (8-year-old female). The bottom panel demonstrates absence of late gadolinium enhancement (LGE) in patients 2 and 3. Myocardial null times were recognized as too short in patient 4 but could not be repeated due to lack of further patient cooperation; however review of Look Locker images and additional sequences revealed no LGE. Image courtesy of RSNA.