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Myopericarditis — EECC MCQ

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ModerateCardiac ImagingMyopericarditisEECC

A 45-year-old woman with suspected acute pericarditis has fever, pleuritic chest pain, and diffuse concave ST elevation on ECG. Her troponin is mildly elevated at 35 ng/L. Echocardiography shows a small pericardial effusion but normal LV function. When should cardiac MRI be performed?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — After initial treatment if there is diagnostic uncertainty or to assess for myocardial involvement (myopericarditis)

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

Per the 2025 ESC Myocarditis and Pericarditis Guidelines, acute pericarditis is primarily a clinical diagnosis. CMR is indicated to assess for concomitant myocardial involvement (myopericarditis) if troponin is elevated, or for diagnostic uncertainty. The mildly elevated troponin here warrants CMR assessment. Immediate CMR (A) is not necessary. Excluding CMR entirely (B) would miss potential myocardial involvement. CMR is not dependent on effusion size (D) or recurrence (E) alone.

Reference: ESC (2025): Guidelines for the Management of Myocarditis and Pericarditis