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(Circulation. 2005;111:e158-e160.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Follow-Up of Cardiac Sarcoidosis by Magnetic Resonance Imaging

Norbert I. Stauder, MD; Birgit Bader, MD; Michael Fenchel, MD; Ulrich Kramer, MD; Volker Kühlkamp, MD; Stephan Miller, MD

From the Departments of Diagnostic Radiology (N.I.S., M.F., U.K., S.M.) and Cardiology (B.B., V.K.), Eberhard Karls University, Tuebingen, Germany.

Reprint requests to Norbert I. Stauder, MD, Department of Diagnostic Radiology, Eberhard Karls University, Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen, Germany 72076. E-mail norbert.stauder{at}med.uni-tuebingen.de

A 27-year-old patient presented with a chief complaint of 2 months of increasing dyspnea, vertigo, and performance decline on exertion. The physical examination and echocardiography results were unremarkable. Admission chest radiograph revealed bilateral hilar adenopathy Figure 1. An ECG showed borderline first-degree atrioventricular block. Heart rate at baseline was 68 bpm. During a stress test, atrioventricular conduction abnormalities progressed until complete heart block resulted, and the heart rate decreased to 35 bpm Figure 2. Magnetic resonance imaging (MRI) of the heart showed (on T₁-weighted images after application of 0.1 mmol/kg body weight gadolinium diethylenetriamine pentaacetic acid [Gd-DTPA]) multiple, well-demarcated, contrast-enhanced granulomas Figure 3; corresponding wall thickening on gradient-echo images Figure 4; and severe edema associated with granulomatous inflammation on T₂-weighted images Figure 5 within the posterior, lateral, and anteroseptal left ventricular walls. Sarcoidosis was confirmed by lymph node biopsy. On follow-up 6 months later after initiation of steroid therapy (prednisolone 1 mg/kg body weight initially for 6 weeks, then a consecutive reduction to 0.25 mg/kg body weight), the patient was asymptomatic. On MRI the contrast-enhanced areas were diminished Figure 6, and no edema was found on T₂-weighted images, corresponding to postinflammatory scarring.

View larger version (157K): [in this window] [in a new window]   Figure 1. X-ray film of thorax: bilateral hilar lymphadenopathy (white arrows).

View larger version (51K): [in this window] [in a new window]   Figure 2. A, ECG at rest: first-degree atrioventricular block, heart rate 68 bpm. B, ECG during stress: complete heart block. Heart rate decreased to 35 bpm and patient developed vertigo.

View larger version (177K): [in this window] [in a new window]   Figure 3. Gd-DTPA-enhanced MRI in long-axis view obtained before steroid therapy shows 2 inflammatory granulomas in inferior wall (white arrows).

View larger version (164K): [in this window] [in a new window]   Figure 4. On true fast imaging with steady-state precession, gradient-echo image in long-axis view shows corresponding wall thickening (black arrows).

View larger version (166K): [in this window] [in a new window]   Figure 5. T2-weighted, long-axis black-blood, single-shot, fast-spin echo sequence showing acute edema as increased signal intensity in corresponding area of granulomatous infiltration (white arrows).

View larger version (138K): [in this window] [in a new window]   Figure 6. Six-month follow-up Gd-DTPA-enhanced MRI image in long-axis view, showing marked diminution of enhanced granulomas due to fibrosis leading to postinflammatorry scarring (white arrows).

Myocardial sarcoid was first reported by Bernstein et al¹ in 1929. Clinical manifestations are arrhythmias, conduction disturbances, heart block, pericardial effusion, and sudden death. Clinically recognizable involvement of the heart occurs in 5% of patients. The prevalence of direct involvement is estimated to be 20% to 27% in autopsy series. Cardiac MRI is a useful noninvasive method for early diagnosis and follow-up of cardiac sarcoidosis.

	Reference

Top Reference

 

1. Bernstein M, Konzelmann FW, Sidlick DM. Boeck’s sarcoid: report of a case with visceral involvement. Arch Intern Med. 1929; 44: 721–734.[CrossRef]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stauder, N. I. Articles by Miller, S. Search for Related Content PubMed PubMed Citation Articles by Stauder, N. I. Articles by Miller, S. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Cardiomyopathy MRI Scans Sarcoidosis Hazardous Substances DB PREDNISONE Related Collections CT and MRI Related Article