One of the most common causes of inflammation of the heart muscle (myocarditis, Figure 1) or the pericardium (pericarditis, Figure 2) is infection by viruses or bacteria. Autoimmune diseases or toxic reactions are less frequently responsible. Sarcoidosis(Figure 3) as a granulomatous multisystem disease poses a particular diagnostic challenge. Imaging can be used to assess various organ involvement, in particular cardiac manifestations and their prognostic implications. Other important diseases are endomyocardial fibrosis or changes in the heart, e.g. in the case of a COVID-19 infection.
Cardiac magnetic resonance imaging (MRI) is the gold standard for the imaging diagnosis of these diseases.
In contrast, cardiac CT is used for imaging inflammations or infections of the heart valves (so-called endocarditis). With CT it is possible to detect changes such as vegetations, pseudoaneurysms or valve dehiscences(Figure 4). This is also possible with CT in patients who have already had a heart valve replaced or operated on.
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Abbildung 1: Herz-MRI eines Patienten mit akuter Myokarditis der seitlichen Wand der linken Herzkammer (rote Pfeile). -
Abbildung 2: Herz-MRI einer Patientin mit zirkulärer Entzündung des Perikards (rote Pfeile), ohne Befall des Myokards. -
Abbildung 3: Herz-MRI bei einem Patienten mit kardialer Sarkoidose der basalen Vorderwand der linken Herzkammer (rote Pfeile). -
Abbildung 4: Herz-CT eines Patienten mit Endokarditis. Es finden sich Vegetationen auf der mechanischen Aortenklappe, Pseudoaneurysmata sowie eine Dehiszenz der Klappe als typische Befund dieser Erkrankung.
