title: Cardiac noradrenergic denervation in a patient with multiple symmetric lipomatosis.
abstract: BACKGROUND
  Multiple symmetric lipomatosis (MSL) is a rare disease of unknown etiology characterized by multiple subcutaneous lipomas with a symmetrical distribution. One interesting aspect about MSL is a high incidence of sudden cardiac death despite a low incidence of metabolic syndrome and coronary arterial disease. Autonomic nervous system dysfunction may probably explain this feature of MSL.
  
  
  METHODS
  A 74-year-old man was admitted with acute heart failure and atrial fibrillation. He had a morphotype suggestive of MLS. A (123)I-metaiodobenzylguanidine myocardial scintigraphy was conducted for evaluation of cardiac autonomic nervous integrity, since atrial fibrillation precluded the classical approach. The heart-to-mediastinum ratio was 1.68 (normal >2.2). Ischemia was not detected in myocardial perfusion scintigraphy.
  
  
  CONCLUSIONS
  We present the first reported case of MSL autonomic neuropathy detected by (123)I- metaiodobenzylguanidine scintigraphy and suggest that this approach could play a role in MSL stratification by risk of sudden cardiac death and in exploring MSL disease mechanisms.
authors.affiliation: Clínica Universitária de Medicina II, CHLN - Hospital de Santa Maria, Universidade de Lisboa, Lisboa, Portugal. vfonseca@campus.ul.pt
authors.forename: Válter R
authors.initials: VR
authors.lastname: Fonseca
authors.forename: Carlos
authors.initials: C
authors.lastname: Freitas
authors.forename: Mireille
authors.initials: M
authors.lastname: Palmeira
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferreira
authors.forename: Rui
authors.initials: R
authors.lastname: Victorino
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D003714:Denervation; D004417:Dyspnea / Q000209:etiology; D006321:Heart / Q000294:innervation; D006801:Humans; D008069:Lipomatosis, Multiple Symmetrical / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine