Circulation. 2005;111:e383-e384
doi: 10.1161/CIRCULATIONAHA.104.489294
(Circulation. 2005;111:e383-e384.)
© 2005 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Reversible Right Ventricular Hypertrophy Due to Cardiac Sarcoidosis
Hideo Okamura, MD;
Yoichi Goto, MD, PhD;
Masahiro Terashima, MD, PhD;
Shuichi Takagi, MD, PhD;
H. Ishibashi-Ueda, MD, PhD;
Hiroshi Nonogi, MD, PhD
From the Division of Cardiology, National Cardiovascular Center, Osaka, Japan.
Correspondence to Yoichi Goto, MD, PhD, Division of Cardiology, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565 Japan. E-mail ygoto{at}hsp.ncvc.go.jp
A 42-year-old man was admitted to our hospital with shortness of breath on light effort. An ECG revealed advanced AV block (Figure 1A), and a chest CT scan showed markedly increased thickness (12 mm) of the right ventricular wall (Figure 2A). The endomyocardial biopsy showed a noncaseous epithelioid cell granuloma with giant cells, which supported the diagnosis of cardiac sarcoidosis (Figure 3). There was no evidence of systemic inflammation, such as fever, elevated C-reactive protein, leukocytosis, or eosinophilia. Treatment with oral prednisolone (40 mg daily) was started, and the "hypertrophy" of the right ventricular wall disappeared (wall thickness 6 mm) and AV conduction normalized within 2 months (Figures 1B and 2
B). This reversible right ventricular hypertrophy was also confirmed by serial echocardiography. Because of the reversible nature, the right ventricular hypertrophy was considered to reflect myocardial cell infiltration or edema. No recurrence has been detected in the subsequent 2 years with a reduced dose of prednisolone (10 mg/d).
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Figure 1. A, ECG on admission showed advanced AV block with ventricular escape complexes. B, After treatment with oral prednisolone for 1 month, AV conduction dramatically improved to normal PQ interval.
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Figure 2. A, Chest CT scan showed markedly increased thickness (12 mm) of right ventricular wall (arrowheads). B, Hypertrophy of right ventricle disappeared (wall thickness 6 mm) within 2 months after steroid therapy (arrowheads).
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Figure 3. Photomicrograph of endomyocardial biopsy: Noncaseous epithelioid granuloma with giant cells is seen. Hematoxylin and eosin stain (H.E.), original magnification x200.
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