Article Text

Download PDFPDF
Fulminant myocarditis spreading from the right ventricle treated with extracorporeal membrane oxygenation and impella
  1. Chihiro Karashima1,
  2. Noritaka Fujimoto1,
  3. Keisuke Yonezu2 and
  4. Naohiko Takahashi2
  1. 1Cardiology, Beppu Medical Center, Beppu, Japan
  2. 2Department of Cardiology and Clinical Examination, Oita University School of Medicine Graduate School of Medicine, Oita-gun, Japan
  1. Correspondence to Dr Chihiro Karashima; chi.karashima{at}


Although the pathogenesis of fulminant myocarditis varies, it is usually recognised by symptoms such as chest pain or syncope, echographic findings such as abnormal left ventricular (LV) wall motion, elevated cardiac enzymes and arrhythmias. We encountered a case of acute myocarditis with syncope, electrocardiographic changes suggestive of coronary artery disease in the inferior wall with abnormal wall motion in the right ventricle, which eventually developed into fulminant disease. Multidetector CT showed a contrast effect localised to the right ventricle in the late-contrast phase, suggesting a right ventricular myocardial injury. Thereafter, the LV function rapidly decreased. Finally, mechanical circulatory support with extracorporeal membrane oxygenation and an intra-aortic balloon pump was needed. A myocardial biopsy of the right ventricular septum showed severe degenerative findings such as myocyte tearing and segmentation with infiltration of inflammatory cells including lymphocytes. After insertion of an Impella pump, the right ventricular function gradually improved.

  • Cardiovascular medicine
  • Adult intensive care
  • Radiology

Statistics from


  • Contributors All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the BMJ case reports. Category 1: conception and design of study and acquisition of data: CK; analysis and/or interpretation of data: CK, NF, KY and NT. Category 2: drafting the manuscript: CK; revising the manuscript critically for important intellectual content: CK, NF, KY and NT. Category 3: approval of the version of the manuscript to be published : NF, KY and NT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.