(Circulation. 1998;97:1306-1307.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Cardiac Sarcoidosis
Takayuki Shindo, MD;
Hiroki Kurihara, MD;
Nobuya Ohishi, MD;
Hiroyuki Morita, MD;
Koji Maemua, MD;
Yukiko Kurihara, MD;
Hideo Tsuneyoshi, MD;
Hyung-in Chi, MD;
Kazuhide Yamaoki, MD;
; Yoshio Yazaki, MD
From the Third Department of Internal Medicine (T.S., H.K., N.O., H.M.,
K.M., Y.K., K.Y., Y.Y.) and Tokyo Hitachi Hospital (H.T., H-i.C.), Tokyo,
Japan.
Correspondence to Takayuki Shindo, MD, The Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.
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.
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Figure 1. Biopsy specimen demonstrates many
noncaseating granulomas with giant cells in subcutaneous nodule.
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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.
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Figure 3. Top, Parasternal long-axial
echocardiographic view. Arrows show wall thinning and
increased echogenicity of inferior wall. Parasternal
short-axial view showing end-diastolic (lower left) and
end-systolic (lower right) phases.
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Figure 5. 67Ga scintigram showing
anterior (left) and posterior (right) views. Abnormal uptake is
detected at heart (arrows).
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Footnotes
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.
