Cardiac sarcoidosis

Discussion:

This case illustrates the findings of cardiac and pulmonary sarcoidosis.

The pulmonary and mediastinal findings are typical and comprise:

  • symmetric, bilateral hilar and right paratracheal lymphadenopathy, also known as Garland's triad or 1-2-3 sign, together with subcarinal lymphadenopathy
  • a micronodular lung pattern with a perilymphatic distribution predominant in the upper and middle zones

The cardiac findings are:

  • an extensive, circular pericardial effusion
  • a patchy intramyocardial/subepicardial late gadolinium enhancement
  • acute inflammatory changes of the myocardium in the first MRI, which apparently had resolved after a course of systemic immunosuppressive therapy

There are reports in the literature, indicating that increased myocardial T2 signal representing cardiac edema in conjunction with late gadolinium enhancement (LGE) can predict cardiac arrhythmia risk in cardiac sarcoidosis 4. T1 and T2 mapping seem to have the potential to characterize disease activity in addition to LGE and to monitor the response to immunosuppressive therapy 3-7.  

The cardiac MRI, which is shown first in this case (last in the timeline), was conducted to find out if there were acute inflammatory changes responsible for the patient's ventricular extrasystoles and whether her anti-inflammatory medications had to be adjusted.

The late gadolinium enhancement (LGE) is unchanged in comparison to the previous MRI, but this time there were no acute inflammatory signs and cardiac function was normal.

On grounds of both clinical and MRI findings, the patients anti-inflammatory medications were left unchanged.

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