Page 14 - Del-Medical-Journal-June-2015-Final.indd
P. 14
CASE REPORT
ANSWER:
CARDIAC SARCOIDOSIS
Sarcoidosis is a granulomatosis of an unknown etiology affecting
multiple organs, though recent studies have shown a link between the disease pathogenesis and genetic and environmental factors.1 The highest incidence of this disease has been shown in African Americans with
about threefold higher age-adjusted annual incidence (35.5 per 100,000) compared with Caucasians (10.9 per 100,000).2 Cardiac sarcoidosis is from asymptomatic left ventricular involvement to fatal arrhythmias.
High resolution CT of the chest is sensitive for detection of pulmonary delineation of enlarged mediastinal and hilar lymph nodes in sarcoidosis, as illustrated in the presented case (Figure 1).3 Due to its superior soft tissue contrast and high spatial resolution, MRI has been shown to be
the imaging modality of choice for evaluation and diagnosis of suspected cardiac sarcoidosis.4 Myocardial sarcoidosis can be frequently detected
on MRI as abnormal delayed myocardial hyperenhancement after administration of intravenous gadolinium. The abnormal myocardial enhancement has a variable appearance, but it most often focal, patchy, and globular, commonly found in the left ventricular basal and lateral segments, and does not conform to a vascular or subendocardial territory, thus differentiating it from myocardial infarction.5 Right ventricular case (Figure 2). In particular, the abnormal delayed right ventricular myocardial hyperenhancement in this patient occurred in a diffuse transmural pattern, which is more typical for a right ventricular infarct. clinical presentation, allowed for the diagnosis of cardiac sarcoidosis,
CONTRIBUTING AUTHORS
■ CHETE EZE-NLIAM, MD is a Cardiology Fellow at Christiana Care Health System in Newark, Del.
■ MANDIP GAKHAL, MD is a Radiologist in the Department of Radiology at Christiana Care Health System in Newark, Del.
REFERENCES
1.
2.
3.
4.
5.
Rybicki BA, Iannuzzi MC. Epidemiology of sarcoidosis: recent advances and future prospects. Semin Respir Crit Care Med. 2007;28:22-35.
Rybicki BA, Major M, Popovich J, Maliarik MJ, Iannuzzi MC. Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol. 1997;145:234-241.
Iwai K, Sekiguti M, Hosoda Y, et al: Racial difference in cardiac sarcoidosis incidence observed at autopsy. Sarcoidosis. 1994;11:26-31.
Tadamura E, Yamamuro M, Kubo S, et al: Effectiveness of delayed enhanced MRI for identification of cardiac sarcoidosis: comparison with radionuclide imaging. AJR Am J Roentgenol. 2005;185:110-115.
Smedema JP, Snoep G, van Kroonenburgh MP, et
al: Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol. 2005;45:1683-1690.
174
Del Med J | June 2015 | Vol. 87 | No. 6
