title: [A woman with a chronic cough and dyspnoea].
abstract: A previously healthy woman in her forties with a six-month history  of persistent coughing, breathlessness and fatigue was referred to  our hospital for further evaluation. She was initially treated with  antibiotics for a possible respiratory tract infection but with  only minor effect. A chest x-ray and computer tomography (CT) of  the thorax demonstrated a solid tumour in the right lung hilus.  Bronchoscopy revealed slight oedema of the bronchial mucous membrane  in the area in question. Cytological examination of bronchoalveolar  lavage fluid (BAL) showed normal respiratory epithelial cells. Histological examination  of a needle biopsy from the tumour showed lymphoproliferative changes  of uncertain cause. Magnetic resonance imaging (MRI) of the thorax  provided no further information. An electrocardiogram (ECG) revealed  signs of left ventricular hypertrophy and sinus bradycardia. Her  complaints were palpitations, mild exertional dyspnoea and attenuated  heart rate response to exercise. Echocardiography showed increased  wall thickness with heterogeneous echogenicity in both ventricles,  a slightly enlarged left atrium and mild mitral regurgitation. Tissue Doppler  measurements showed impaired relaxation. These findings were suggestive  of restrictive cardiomyopathy with diastolic dysfunction. Cardiac  MRI confirmed the echocardiographic findings. The tumour was removed  by thoracotomy and was shown to be made up of lymphatic tissue with  granulomas, consistent with sarcoidosis. The restrictive cardiomyopathy  was regarded as a cardiac manifestation of sarcoidosis. The patient  was treated with corticosteroids. Clinical follow up with cardiac  MRI and echocardiography did not reveal any progression of the cardiac  involvement. Cardiac sarcoidosis must be considered in all sarcoid  patients because of its significance for prognosis and treatment.
authors: Kardiologisk avdeling, Oslo universitetssykehus, Ullevål, Norway. zika@ulleval.no
authors: Ziaullah
authors: Z
authors: Kamal
authors: Geir Øystein
authors: GØ
authors: Andersen
authors: Gunnar
authors: G
authors: Smith
authors: Frøydis
authors: F
authors: Stornes
authors: Knut Haakon
authors: KH
authors: Stensæth
authors: Jan
authors: J
authors: Eritsland
mesh_terms: D000328:Adult; D002313:Cardiomyopathy, Restrictive / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed