Active cardiac sarcoidosis on standard chest computed tomography

Active cardiac sarcoidosis on standard chest computed tomography Reversible myocardial perfusion defects for kidney transplantation 1025 21. Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ et al. . Disease (APPROACH) Investigators. Survival after coronary revascularization Chronic kidney disease, mortality, and treatment strategies among patients with among patients with kidney disease. Circulation 2004;110:1890–5. clinically significant coronary artery disease. J Am Soc Nephrol 2003;14:2373–80. 23. Chang TI, Shilane D, Kazi DS, Montez-Rath ME, Hlatky MA, Winkelmayer WC. 22. Hemmelgarn BR, Southern D, Culleton BF, Mitchell LB, Knudtson ML, Ghali Multivessel coronary artery bypass grafting versus percutaneous coronary inter- WA. Alberta Provincial Project for Outcomes Assessment in Coronary Heart . vention in ESRD. J Am Soc Nephrol 2012;23:2042–9. IMAGE FOCUS doi:10.1093/ehjci/jey075 Online publish-ahead-of-print 30 May 2018 .................................................................................................................................................... 1,2 1,2 2 1,2 David J. Murphy , Manil Subesinghe , Imran Rashid , and Eliana Reyes-Torres 1 2 King’s College London & Guy’s and St Thomas’ PET Centre, Westminster Bridge road, London SE1 7EH, UK; and School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK * Corresponding author. Tel: 144 20 7188 4988; Fax: 144 20 7620 0790. E-mail: murphy.84@gmail.com A 50-year old female patient underwent a standard non-electrocardiogram (ECG) gated computed tomography (CT) thorax with intravenous contrast for worsening constitutional symptoms. She had a known diagnosis of extra-cardiac sarcoidosis from a previous lymph node biopsy and was not on immunosuppression. A standard chest CT demonstrated multistation mediastinal lymphadenopathy and multiple peribron- chovascular pulmonary nodules. There was also a focal, hypoattenuating, thickened appearance of the left ventricular (LV) basal anteroseptum (A, axial CT thorax, arrow; B, LV short axis CT multi-planar reformat, arrow), which raised the suspicion of cardiac sarcoid involvement. A [18F]fluoro- D-glucose (FDG) positron emission tomog- raphy-computed tomography (PET-CT) scan demonstrated increased myocardial metabolic activity in the basal septum (C, arrow), with a cardiac magnetic resonance imaging (CMR) scan showing corresponding oedema in the basal septum, as demonstrated on this quantitative colour T2 map (D, arrow). These findings confirmed the diagnosis of active cardiac sarcoidosis and the patient was placed on immunosuppression. Cardiac sarcoidosis is diagnosed using a combination of histopathological, clinical, ECG, and cardiac imaging findings, with CMR and F-FDG PET-CT playing a complementary role. Delayed iodine enhancement cardiac CT can demonstrate areas of cardiac sarcoid related LV scar, but the role of CT is usually limited to the assessment of extra-cardiac sarcoidosis. To our knowledge, this is the first reported case of active cardiac sarcoidosis visible on standard chest CT, manifesting as oedematous LV myocardial thickening. In a different clinical scenario, the same CT appearance could be caused by myocarditis or hypertrophic cardiomyopathy. This case underlies the importance of closely interrogating the myocardium on all chest CTs in patients with known or suspected sarcoid. Conflict of interest: None declared. Published on behalf of the European Society of Cardiology. All rights reserved. V C The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/9/1025/5025713 by Ed 'DeepDyve' Gillespie user on 22 August 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Active cardiac sarcoidosis on standard chest computed tomography

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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2047-2404
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10.1093/ehjci/jey075
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Abstract

Reversible myocardial perfusion defects for kidney transplantation 1025 21. Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ et al. . Disease (APPROACH) Investigators. Survival after coronary revascularization Chronic kidney disease, mortality, and treatment strategies among patients with among patients with kidney disease. Circulation 2004;110:1890–5. clinically significant coronary artery disease. J Am Soc Nephrol 2003;14:2373–80. 23. Chang TI, Shilane D, Kazi DS, Montez-Rath ME, Hlatky MA, Winkelmayer WC. 22. Hemmelgarn BR, Southern D, Culleton BF, Mitchell LB, Knudtson ML, Ghali Multivessel coronary artery bypass grafting versus percutaneous coronary inter- WA. Alberta Provincial Project for Outcomes Assessment in Coronary Heart . vention in ESRD. J Am Soc Nephrol 2012;23:2042–9. IMAGE FOCUS doi:10.1093/ehjci/jey075 Online publish-ahead-of-print 30 May 2018 .................................................................................................................................................... 1,2 1,2 2 1,2 David J. Murphy , Manil Subesinghe , Imran Rashid , and Eliana Reyes-Torres 1 2 King’s College London & Guy’s and St Thomas’ PET Centre, Westminster Bridge road, London SE1 7EH, UK; and School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK * Corresponding author. Tel: 144 20 7188 4988; Fax: 144 20 7620 0790. E-mail: murphy.84@gmail.com A 50-year old female patient underwent a standard non-electrocardiogram (ECG) gated computed tomography (CT) thorax with intravenous contrast for worsening constitutional symptoms. She had a known diagnosis of extra-cardiac sarcoidosis from a previous lymph node biopsy and was not on immunosuppression. A standard chest CT demonstrated multistation mediastinal lymphadenopathy and multiple peribron- chovascular pulmonary nodules. There was also a focal, hypoattenuating, thickened appearance of the left ventricular (LV) basal anteroseptum (A, axial CT thorax, arrow; B, LV short axis CT multi-planar reformat, arrow), which raised the suspicion of cardiac sarcoid involvement. A [18F]fluoro- D-glucose (FDG) positron emission tomog- raphy-computed tomography (PET-CT) scan demonstrated increased myocardial metabolic activity in the basal septum (C, arrow), with a cardiac magnetic resonance imaging (CMR) scan showing corresponding oedema in the basal septum, as demonstrated on this quantitative colour T2 map (D, arrow). These findings confirmed the diagnosis of active cardiac sarcoidosis and the patient was placed on immunosuppression. Cardiac sarcoidosis is diagnosed using a combination of histopathological, clinical, ECG, and cardiac imaging findings, with CMR and F-FDG PET-CT playing a complementary role. Delayed iodine enhancement cardiac CT can demonstrate areas of cardiac sarcoid related LV scar, but the role of CT is usually limited to the assessment of extra-cardiac sarcoidosis. To our knowledge, this is the first reported case of active cardiac sarcoidosis visible on standard chest CT, manifesting as oedematous LV myocardial thickening. In a different clinical scenario, the same CT appearance could be caused by myocarditis or hypertrophic cardiomyopathy. This case underlies the importance of closely interrogating the myocardium on all chest CTs in patients with known or suspected sarcoid. Conflict of interest: None declared. Published on behalf of the European Society of Cardiology. All rights reserved. V C The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/9/1025/5025713 by Ed 'DeepDyve' Gillespie user on 22 August 2018

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: Sep 1, 2018

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