67Ga Imaging and Histology
A 23-year-old man was admitted to Niigata Prefectural Shibata Hospital in September 1992 because of sustained ventricular tachycardia and cardiogenic shock. After cardioversion of the ventricular tachycardia, his ECG showed sinus rhythm, left axis deviation, complete right bundle branch block, and left anterior fascicular block. The cardiac silhouette was slightly enlarged on chest x-ray films, and hilar lymphoadenopathy was present. Moderate leukocytosis (11 000/mL), liver injury, and moderate renal insufficiency were found, with moderate increase of serum angiotensin-converting enzyme (ACE) (42.2 IU/L) and lysosomes (15.5 mg/L). Asymmetric left ventricular hypertrophy was initially observed by echocardiogram, then hypokinesia and thinning of the left ventricular wall progressed gradually (percent fractional shortening from 30% to 14%).
Scintigraphic imaging with 67Ga revealed significant abnormal uptake in the heart, eyes, and bilateral hilar lymph nodes (Fig 1⇓). Coronary arteriography revealed a normal coronary artery. Histological examination of the endomyocardial biopsy showed noncaseating granuloma with epithelioid cells (Fig 2⇓). Thus, he was diagnosed as having sarcoidosis with preferential cardiac involvement. After he was given prednisolone, left ventricular function, ACE, and lysosome count slowly improved.
- Copyright © 1995 by American Heart Association