Images in cardiovascular medicine. Magnetic resonance assessment and therapy monitoring of cardiac involvement in Churg-Strauss syndrome.

A 39-year–old man, with a temperature of 38.5°C and sinus tachycardia, was admitted for work-up of chest pain. He had a history of asthma, recurrent pneumonia, sinusitis, and nasal polyposis. Clinical examinations, ECG (Figure 1) and chest x-ray (Figure 2) on admission were suspicious for perimyocarditis. Routine blood analysis revealed an elevated erythrocyte sedimentation rate (88 mm/h; normal 15 mm/h) and a normal leukocyte count (7200/ mm) with 21% eosinophilic granulocytes (normal 1% to 6%). Levels of C-reactive protein and immunoglobulin E were elevated at 14.0 mg/dL (normal 0.1 to 0.5 mg/dL) and 237 U/mL (normal 100 U/mL), respectively. Thus, ChurgStrauss syndrome with perimyocardial involvement was suspected. Because echocardiography could not provide any information on myocardial involvement in this case (Figure 3; for full-motion images, see Movie I in the online-only Data Supplement), the patient was referred for cardiovascular magnetic resonance imaging (CMR; 1.5 Tesla Sonata, Siemens Medical Systems, Erlangen, Germany). Cine images were acquired using fast-gradient echo steady-state free precession sequences that demonstrated increased pericardial thickness (5 mm), as well as small amounts of pericardial effusion (Figure 4). Systolic left ventricular (LV) function was mildly impaired (LV end-diastolic volume 144 mL, LV end-systolic volume 59 mL, and LV ejection fraction 59% (Figure 4; Movie II in the online-only Data Supplement). Ten minutes after injection of 0.2-mmol/kg gadodiamide (Omnis-