Acute severe myocarditis with cardiac thrombus formation ─ A therapeutic challenge


  • Isabel Ayres Pereira Department of Pediatrics, Centro Hospitalar Vila Nova de Gaia e Espinho
  • Cláudia Teles-Silva Department of Pediatrics, Centro Hospitalar Universitário de São João
  • Edite Serrano Gonçalves Department of Cardiology Pediatrics, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João
  • Teresa Cunha da Mota Department of Pediatric Intensive Medicine, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João
  • Maria de Lurdes Lisboa Sequeira Department of Pediatric Intensive Medicine, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João
  • António Augusto Batista Ribeiro Department of Pediatric Intensive Medicine, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João



Campylobacter, cardiac transplant, intracardiac thrombus, myocarditis, thrombectomy


Acute myocarditis is a potentially life-threatening disease in pediatric age, with risk of severe cardiac dysfunction and intracardiac thrombus formation.
A previously healthy 16-year-old boy was admitted to the Pediatric Intensive Care Unit with suspicion of acute myocarditis with multiorgan dysfunction. He reported mucous diarrhea, vomiting, and asthenia with one week of evolution. The echocardiogram revealed moderate-to-severe left ventricle dysfunction with mitral and tricuspid regurgitation and two hyperechoic images suggestive of thrombus, later confirmed by cardiac magnetic resonance. Unfractionated heparin was started on admission. Campylobacter jejuni was isolated from feces. Despite treatment, the clinical picture worsened with systemic arterial embolization. Surgical thrombectomy was performed on day 13, and extracorporeal membrane oxygenation (ECMO) was maintained until day 28. At this time, the boy was submitted to orthotopic cardiac transplantation with favorable postoperative course.
The therapeutic approach in these cases is controversial and should always be multifactorial and multidisciplinary. Despite the inherent risk of complications, thrombectomy should be considered when conservative approaches fail.


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How to Cite

Ayres Pereira I, Teles-Silva C, Serrano Gonçalves E, Cunha da Mota T, de Lurdes Lisboa Sequeira M, Augusto Batista Ribeiro A. Acute severe myocarditis with cardiac thrombus formation ─ A therapeutic challenge. REVNEC [Internet]. 2022Jun.30 [cited 2022Aug.12];31(2):166-71. Available from:



Case Reports