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(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.

View larger version (127K): [in this window] [in a new window]   Figure 1. Biopsy specimen demonstrates many noncaseating granulomas with giant cells in subcutaneous nodule.

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.

View larger version (18K): [in this window] [in a new window]   Figure 2. ECG shows abnormal Q wave in leads II, III, aVF and ST elevation in V5 and V6.

View larger version (113K): [in this window] [in a new window]   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.

View larger version (119K): [in this window] [in a new window]   Figure 4. 201Tl scintigram shows large regional defect at inferior-to-lateral wall.

View larger version (78K): [in this window] [in a new window]   Figure 5. 67Ga scintigram showing anterior (left) and posterior (right) views. Abnormal uptake is detected at heart (arrows).

Footnotes

The editor . . . [Full Text of this Article]