Excerpt

Sarcoidosis, a multisystem granulomatous disorder, remains an enigma—the exact cause, ideal diagnostic method and a definite management are all unclear. Clarity is about the manifestations. The search for key clinical factors to predict disease has been the goal of various investigators. The diagnosis of cardiac sarcoidosis remains a challenging task for clinicians in the absence of a gold standard diagnostic tool. The diagnostic yield of endomyocardial biopsy is rather low1 and moreover the procedure carries significant risk for patients outside expert centers. The heterogeneous nature of the myocardial granulomatous infiltration is often the main cause of diagnostic failure of such procedure.2 Endomyocardial biopsies are often obtained from the RV free wall and apex of the atrioventricular (A-V) septum, but cardiac sarcoidosis may usually involve the basal part of the septum and the lateral wall, areas that are rarely biopsied. As a result, advanced non-invasive imaging modalities are relied upon to reach a clinical working diagnosis of cardiac sarcoidosis. …