Cardiac sarcoidosis complicated with atrioventricular block and wall thinning, edema and fibrosis in left ventricle: Confirmed recovery to normal sinus rhythm and visualization of edema improvement by administration of predonisolone

Miyazaki, Shohko; Funabashi, Nobusada; Nagai, Toshio; Uehara, Masae; Kataoka, Akihisa; Takaoka, Hiroyuki; Ueda, Marehiko; Komuro, Issei

doi:10.1016/j.ijcard.2009.05.047

Cited by 27 publications

(15 citation statements)

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“…10) Thickening of the cardiac wall also could be observed in the ventricular free wall. [11][12][13] In two cases with left ventricular thickening 11,12) and one case with right ventricular thickening, 13) steroid therapy resulted in the normalization of atrioventricular block. The authors thus consider that cardiac hypertrophy would be the early stage of infl ammation.…”

Section: Discussionmentioning

confidence: 96%

Interventricular Septal Thickening as an Early Manifestation of Cardiac Sarcoidosis

et al. 2014

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SummaryWe report an unusual case of cardiac sarcoidosis demonstrated by interventricular septal thickening. A 64-year-old woman was diagnosed with sarcoidosis involving the lungs, eyes, and skin. Three years later, renal dysfunction was detected during a periodic examination and a renal biopsy revealed non-caseating granulomas. Electrocardiogram results were normal, but an echocardiogram revealed thickening of the interventricular septum. Abnormal accumulation of gallium-67 and a perfusion defect in tecnetium-99-methoxyisobutylisonitrile scintigrams occurred in the interventricular septum. Magnetic resonance images showed T2-high intensity in the lesion. We considered the thickening to represent cardiac involvement of sarcoidosis. Oral prednisolone therapy diminished the interventricular septal thickening. (Int Heart J 2014; 55: 181-183) Key words: Interventricular septum S arcoidosis is a multisystem infl ammatory disease of unknown etiology. Interventricular thinning is the most specifi c characteristic feature of cardiac sarcoidosis in echocardiograms, 1) whereas interventricular septal thickening is extremely rare in sarcoidosis patients.2,3) Here, we report an unusual case of cardiac sarcoidosis that presented as interventricular septal thickening. Case ReportIn May 2008, a 64-year-old woman developed eye fl oaters and erythema on the forehead. A chest X-ray fi lm and computed tomography scans revealed enlargement of the bilateral hilar and mediastinal lymph nodes and nodular shadows in the lung fi elds. She was admitted to our hospital for further examination. Her serum angiotensin converting enzyme (ACE) levels were normal (21.2 IU/L, baseline 8.3-21.4 IU/L), but her serum lysozyme levels were elevated (19.0 μg/mL, baseline 5.0-10.2 μg/mL). A gallium-67 scintigram revealed abnormal uptake in the mediastinal and bilateral hilar lymph nodes. An electrocardiogram, 24-hour Holter electrocardiogram, echocardiogram, and tecnetium-99-methoxyisobutylisonitrile scintigram revealed no abnormal fi ndings. A transbronchial lung biopsy and a skin biopsy showed non-caseating granulomas. She was definitively diagnosed with sarcoidosis involving the lungs, eyes, and skin. Routine periodic examination with an electrocardiogram and echocardiogram revealed no abnormality. Her serum creatinine, ACE, and lysozyme levels gradually increased after January 2011, and renal involvement of the sarcoidosis was suspected. In June 2011, she was admitted to our hospital again for further examination. Fine crackles were heard over both lung fi elds. Systolic murmurs were heard at the third intercostal space just left of the sternum. Laboratory data revealed elevated serum levels of ACE (26.5 IU/L, baseline 8.3-21.4 IU/L), lysozyme (27.4 μg/mL, baseline 5.0-10.2 μg/mL), and creatinine (1.95 mg/dL, 0.40 -1.10 mg/dL). Histopathologic examination of kidney biopsy specimens revealed non-caseating epithelioid granulomas with giant cells, compatible with sarcoidosis. Electrocardiogram and 24-hour Holter electrocardiogram findings were norm...

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Section: Discussionmentioning

confidence: 96%

Interventricular Septal Thickening as an Early Manifestation of Cardiac Sarcoidosis

et al. 2014

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“…The presence of LE both on CT and MRI indicate not only myocardial fibrosis, [3][4][5]11) but also edema due to inflammation. 19,20) The latter may occur in active phase cardiac sarcoidosis or acute myocarditis. We have previously determined optimal periods for (18) Ffluorodeoxyglucose positron emission tomography examination in subjects with suspected acute myocarditis; we compared these with endomyocardial biopsy and concluded that acquisition timing may influence the detection of edema due to inflammation in such patients.…”

Section: Study Limitationsmentioning

confidence: 99%

Improved Diagnosis of Detection of Late Enhancement in Left Ventricular Myocardium Using 2nd Generation 320-Slice CT Reconstructed with FIRST in Non-Ischemic Cardiomyopathy

et al. 2018

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Forward Projected Model-based Iterative Reconstruction SoluTion (FIRST) is a new reconstruction technique using CT, which provides successful reconstruction of high-quality CT images, especially in low contrast imaging. To evaluate improvements in the diagnostic accuracy of the detection of abnormal late enhancement (LE) in left-ventricular myocardium (LVM) using 320-slice CT with FIRST, we compared this modality with previous CT methods in patients with non-ischemic cardiomyopathy or a cardiac tumor.This was a retrospective study of 88 patients (56 males; 57 ± 15 years) suspected of having non-ischemic myocardial disease or a cardiac tumor. The first 52 consecutive patients (Group 1) underwent 16-slice CT at 140 kV tube voltage and an average tube current of 337 ± 20 mA, and 1.5 T MRI. The next 18 patients (Group 2) underwent 1st generation 320-slice CT at 120 kV tube voltage and an average tube current of 255 ± 106 mA, and 1.5T MRI; the remaining 18 patients (Group 3) underwent 2nd generation 320-slice CT with FIRST, at 80 kV tube voltage and a tube current of 800 mA, and 1.5T or 3T MRI.On patient-based analysis, no significant differences were observed between the 3 groups. For segment-based analysis, the specificity and overall accuracy were significantly higher (both P < 0.05) in Group 3 than in Group 1. Positive predictive value (PPV) was significantly higher in Group 3 than in Groups 1 and 2.The diagnostic accuracy of LE on CT for detecting myocardial fibrosis determined by late gadolinium-enhanced MRI was improved with the use of 2nd generation 320-slice CT with FIRST, in particular regarding specificity, PPV, and overall accuracy.

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“…Several studies describe increased focal FDG uptake as well as thickened myocardium in the setting of cardiac sarcoidosis, with high sensitivity and moderate to high specificity [35,36]. Cardiac FDG-PET can also be used to follow treatment response [37].…”

Section: Petmentioning

confidence: 99%

Noninvasive imaging in acute myocarditis

Bami

Haddad

Dick

et al. 2016

Current Opinion in Cardiology

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Cardiac sarcoidosis complicated with atrioventricular block and wall thinning, edema and fibrosis in left ventricle: Confirmed recovery to normal sinus rhythm and visualization of edema improvement by administration of predonisolone

Cited by 27 publications

References 19 publications

Interventricular Septal Thickening as an Early Manifestation of Cardiac Sarcoidosis

Interventricular Septal Thickening as an Early Manifestation of Cardiac Sarcoidosis

Improved Diagnosis of Detection of Late Enhancement in Left Ventricular Myocardium Using 2nd Generation 320-Slice CT Reconstructed with FIRST in Non-Ischemic Cardiomyopathy

Noninvasive imaging in acute myocarditis

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