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European Heart Journal Advance Access originally published online on January 25, 2006
European Heart Journal 2006 27(14):1639; doi:10.1093/eurheartj/ehi699
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Cardiac sarcoidosis detected with magnetic resonance imaging

Javier Sanz1,*, Martin Goyenechea1 and Michael Poon2

1 The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
2 Department of Cardiology, Cabrini Medical Center, NY, USA

* Corresponding author. Tel: +1 212 241 6054; fax: +1 914 412 0468. E-mail address: javier.sanz{at}mssm.edu

A 47-year-old woman was admitted for multiple episodes of symptomatic sustained polymorphic ventricular tachycardia. Six weeks earlier, she had been diagnosed of active sarcoidosis (lymph node biopsy demonstrating non-caseating granulomas). A coronary angiogram revealed normal arteries. A cardiac magnetic resonance examination demonstrated severe left ventricular dysfunction (ejection fraction of 27%). Delayed hyperenhancement imaging showed multiple foci of contrast accumulation corresponding to fibrotic and/or inflammatory tissue in the left ventricular wall, predominantly in the intramyocardial and subepicardial layers (Panel A, four-chamber view; Panel B, two chamber view; Panel C, basal short-axis view). Transmural scarring and thinning of the basal septum, a common finding in cardiac sarcoidosis, was also noted (Panels A and C). An endomyocardial biopsy revealed areas of focal fibrosis (asterisk in Panel D) that could explain the magnetic resonance imaging findings, multiple histiocytes (also noted in Panel D), and no evidence of myocarditis or myocyte necrosis. An automatic internal defibrillator was implanted.

Although clinical evidence of myocardial involvement, a leading cause of death in subjects with sarcoidosis, occurs in only 5% of patients, pathological evidence is found in up to 50% of the subjects. Magnetic resonance imaging can non-invasively depict this abnormality.

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
27/14/1639    most recent
ehi699v1
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