Cardiac sarcoidosis evaluated by multimodality imaging.
An asymptomatic 62-year-old female patient with sarcoidosis was referred to our hospital for new-onset right bundle-branch block by electrocardiogram (ECG). She had been diagnosed with sarcoidosis by lymph node biopsy 3 years previously, and followed up by chest X-ray and ECG from then onward. Chest X-ray on admission showed bilateral lymph node enlargement, which was unchanged. Transthoracic echocardiogram showed wall thinning and severe hypokinesis in the basal portion of the left ventricular (LV) posterior-inferior wall, and coronary heart disease was excluded by conventional coronary angiogram. ECG-gated enhanced 320 slice multislice computed tomography revealed contrast defects in the basal portion of the LV posterior-inferior wall with reduced wall thickness in the early phase, which were conversely abnormally enhanced in the late phase, suggesting fibrosis or edema with inflammation. Late gadolinium enhancement in contrast-enhanced magnetic resonance imaging (MRI) was observed in the same region. To evaluate for evidence of inflammation, we performed 67-gallium-citrate scintigraphy, T2-weighted MRI, and fasting 18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET). Although the 67-Ga scintigram showed no significant uptake, T2-weighted MRI revealed high intensity images, and fasting 18F-FDG PET identified increased uptake of FDG in the basal portion of the LV posterior-inferior wall, suggesting inflammation. We started corticosteroid therapy, diagnosing her condition as active cardiac sarcoidosis.
Nomura
Seitaro
S
Funabashi
Nobusada
N
Tsubura
Masahiro
M
Uehara
Masae
M
Shiina
Yumi
Y
Daimon
Michiko
M
Tateno
Kaoru
K
Nagai
Toshio
T
Komuro
Issei
I
D009202:Cardiomyopathies / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D012507:Sarcoidosis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods