Differentiating between immune checkpoint inhibitor-induced myocarditis and cardiac metastasis in a cardio-oncology patient presenting with myocardial infarction: A case report

Figure 1 Electrocardiogram of the patient. A: At presentation; B: Post percutaneous coronary intervention but before corticosteroid administration; C: At discharge.

Figure 2 Cardiac catheterization. A: Left coronary artery, the orange arrow indicates the left anterior descending artery occlusion site; B: Right coronary artery; C-E: Percutaneous coronary intervention process of the left anterior descending; F: Angiography after the percutaneous coronary intervention.

Figure 3 Echocardiography study. A: In the parasternal long axis view increased thickness of the inferior wall when compared to the anterospetal wall can be noted. There is also pericardial effusion (asterisk); B: Short axis view; C and D: Apical views using contrast agents. There is perfusion inhomogeneity of the inferior wall.

Figure 4 Cardiac magnetic resonance imaging study. A-E: Basal short-axis plane; in T1-weighted image the basal inferior wall has mostly isointense signal and a small subepicardial area of mildly hypointense signal compared to the rest of myocardium (A); in T2-weighted (STIR) image the basal inferior wall has mostly hyperintense signal with area of hypointense subendocardial signal (B); in late gadolinium enhancement image there is increased signal intensity in the basal inferior wall (blue arrow) indicative of scar and extremely decreased signal intensity in the subendocardial region (orange arrow). Asterisk indicates pericardial effusion (C); end-diastolic frame post-Gadolinium administration (D); end-systolic frame of the same acquisition (E); F: End-diastolic frame in cine post-gadolinium acquisition in 2-chamber view.