Right ventricular involvement of cardiac sarcoidosis: A comprehensive evaluation using cardiovascular magnetic resonance imaging and positron emission tomography

Excerpt

A 73-year-old woman with a history of cutaneous sarcoidosis (Figure 1A, a gift from Dr. Maya Takazawa, Department of Dermatology) presented with palpitations and was referred to a cardiologist. Electrocardiography showed normal sinus rhythm and complete right bundle branch block (Figure 1B); echocardiography showed a left ventricular (LV) apical aneurysm; and coronary computed tomography (CT) angiography ruled out obstructive coronary artery disease. Cardiovascular magnetic resonance (CMR) cine imaging showed LV dysfunction with normal global right ventricular (RV) function (Supplemental Movies); however, CMR feature tracking analysis using dedicated software (Vitrea; Canon Medical Systems, Otawara, Japan; Figure 1C, D) revealed regional RV dyssynchrony and reduced circumferential strain in the anterior RV free wall (Figure 1D, arrows; segments of the LV and RV walls and regional strain values are presented with the same color). Late gadolinium enhancement (LGE) imaging showed subepicardial and mid-wall enhancement predominantly distributed in the interventricular septum and the anterior wall of the LV and RV (Figure 1E, arrow). Subsequent ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT revealed abnormal FDG uptake located in the same areas (Figure 1F, G, arrow). She was diagnosed with cardiac sarcoidosis and started prednisolone 30 mg daily.

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