This 34-year-old female patient came to the ambulatory clinic complaining of a few subcutaneous nodular lesions in both thighs. A skin biopsy was performed, and the specimen demonstrated typical noncaseating granulomas with giant cells (Fig 1⇓). A chest roentgenogram revealed reticular shadows in both lung fields, showing stage II sarcoidosis.
Six months later, the ECG showed the appearance of abnormal Q waves in leads II, III, and aVF and ST elevation in V5 and V6 (Fig 2⇓). Echocardiography revealed focal wall thinning and increased echogenicity of the inferior wall. The anterior-to-lateral wall showed hypokinesis, and the inferior wall showed akinesis (Fig 3⇓). A 201Tl scintigram revealed a large regional defect at the inferior-to-lateral wall (Fig 4⇓). A 67Ga scintigram showed abnormal uptake in the same portion (Fig 5⇓). Coronary angiography detected no stenotic lesions (data not shown). The patient was diagnosed as having cardiac sarcoidosis and is now receiving steroid treatment.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 1998 by American Heart Association