Myocardial edema

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Myocardial edema refers to an increased water content of the myocardium particularly within the extracellular interstitium .

Clinical presentation

Myocardial edema often reflects an acute or subacute cardiac event, most often either ischemic or inflammatory and thus can be associated with chest pain or clinical signs of cardiac insufficiency.

Pathology

Myocardial edema develops as a result of a dysbalance between the microvascular fluid filtration and the removal via a network of lymphatic capillaries from the myocardial interstitium , and is considered as a marker of myocardial injury .

Etiology

Myocardial edema is present in a large number of cardiac pathologies acute or chronic :

myocardial ischemia, myocardial infarction
reperfusion injury
myocardial inflammation
- myocarditis, cardiac sarcoidosis (active)
- Tako-tsubo cardiomyopathy
sepsis
cardiac amyloidosis
pulmonary hypertension
arterial hypertension
cardiopulmonary bypass
cardiac transplantation
- preservation/reperfusion
- transplant rejection
cardioplegic arrest
cardiac contusion

Radiographic features

MRI

Myocardial edema can be seen in T2-weighted images if focal, if diffuse it can be assessed with myocardial mapping techniques.

Signal characteristics

T2/STIR: hyperintensity

T2-mapping: increased T2 [ms]

T1-mapping: increased T1 [ms]

ECV: increased