Cardiac sarcoidosis diagnosed by multimodality imaging

Abstract

A 66-year-old woman presented with frequent premature ventricular contractions (PVC) and akinesis of the basal septum on echocardiography. Coronary angiography was normal. Cardiac magnetic resonance showed mid-wall enhancement. Positron emission tomography showed a perfusion defect at the same location using 13N-ammonia, but increased 18-fluorodeoxyglucose uptake. These findings supported the diagnosis of cardiac sarcoidosis. High-dose steroids initially reduced frequency of PVCs but had to be withdrawn due to severe side effects. An ICD was implanted. Our case demonstrates the utility of multimodality imaging to diagnose and guide management of this entity.

Circumferential extent of thinning of the basal muscular ventricular septum in a case of cardiac sarcoidosis

“…In cases of cardiac sarcoidosis, focal thinning of the crest of the muscular ventricular septum supporting the right coronary aortic sinus is a characteristic morphological finding often demonstrated on an echocardiographic parasternal long‐axis image. The mechanism of preferential involvement of the basal ventricular septum, however, has not been elucidated.…”

“…In cases of cardiac sarcoidosis, focal thinning of the basal ventricular septum supporting the right coronary aortic sinus is a characteristic finding, usually detected on the parasternal long-axis view during transthoracic echocardiography. 1 In the present case, circumferential extent of the thinning of the basal ventricular septum could be evaluated using electrocardiography-gated computed tomography, which was incidentally performed as preprocedural coronary evaluation before a cardiac resynchronization therapy.…”