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Background. Pediatric myocarditis often presents with nonspecific manifestations, making early recognition in the emergency department (ED) challenging. In Vietnam, data describing the clinical and diagnostic features of pediatric myocarditis at ED presentation remain limited. This study aimed to describe the clinical characteristics, chest X-ray (CXR), and electrocardiographic (ECG) findings of children diagnosed with acute myocarditis at ED admission. Methods. We conducted a retrospective descriptive case series of pediatric patients diagnosed with acute myocarditis and admitted to the Emergency Department of Vietnam National Children’s Hospital between February 2020 and October 2022. Myocarditis was diagnosed according to the 2013 European Society of Cardiology criteria, based on compatible clinical features combined with supportive laboratory, ECG, and imaging findings. Clinical manifestations, CXR, and ECG abnormalities were analyzed across age groups, and initial ED management outcomes were recorded. Results. Forty-eight pediatric patients were included (mean age, 6.2 ± 4.7 years). Tachypnea (79.2%) and tachycardia (75.0%) were the most frequent presenting signs. Respiratory failure occurred in 100% of infants, 75.0% of children aged 1–5 years, and 34.8% of those aged 6–15 years. Heart failure was observed in 85.4% of patients, and shock in 45.8%. Gastrointestinal symptoms, including vomiting (47.9%) and abdominal pain (20.8%), as well as chest pain (20.8%), were more common in older children. Cardiomegaly on CXR was present in 62.5% of cases. ECG abnormalities were identified in 70.8% of patients, most commonly atrioventricular block and premature ventricular contractions (each 18.8%), with ST-segment elevation in 16.7%. Conclusion. Pediatric myocarditis shows age-dependent and largely nonspecific presentations in the ED. Early suspicion and rapid assessment using ECG and chest X-ray are essential to support timely recognition and appropriate escalation of care.