scholarly journals CMR Features in Cardiac Sarcoidosis

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Sparsh Prasher ◽  
Phong T. Lee ◽  
Marc Dweck ◽  
John R. Payne
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Signs And Symptoms ◽  
Epithelioid Cell ◽  
Unknown Aetiology ◽  
Epithelioid Cell Granuloma ◽  
Organ Systems ◽  
Diagnostic Difficulties ◽  
Life Threatening

Sarcoidosis is a multisystemic disorder of unknown aetiology characterised by the formation of noncaseating epithelioid cell granuloma involving various organ systems. Cardiac involvement has an important prognostic factor as it can present with life-threatening arrythmias and sudden death. Here, we present a case of cardiac sarcoidosis in a 46-year-old gentleman who presented with nonspecific signs and symptoms. We also discuss diagnostic difficulties especially when cardiac involvement is the only clinical sign. In this case, cardiac magnetic resonance (CMR) played an important role in the diagnosis and followup of our patient.

scholarly journals Cardiac Sarcoidosis Culminating in Severe Biventricular Failure

2009 ◽  
Vol 2009 ◽  
pp. 1-3
Author(s):  
Takefumi Ozaki ◽  
Noritomo Ohnuma ◽  
Norihiro Shimizu ◽  
Atsushi Hasegawa ◽  
Masashi Horimoto
Keyword(s):  
Cardiac Sarcoidosis ◽  
Posterior Wall ◽  
Myocardial Scintigraphy ◽  
Epithelioid Cell ◽  
Right Atrial ◽  
Lv Function ◽  
Exertional Dyspnea ◽  
Epithelioid Cell Granuloma ◽  
Conventional Medical Therapy ◽  
Biventricular Failure

A 59-year-old woman with a history of lung sarcoidosis developed general edema and exertional dyspnea. An electrocardiogram showed first-degree atrioventricular block with complete right bundle branch block. Chest X-ray showed cardiomegaly. Echocardiography showed diffuse and severe hypokinesis of the left ventricle (LV) and biventricular enlargement with severe tricuspid regurgitation. Myocardial scintigraphy disclosed a perfusion defect at the ventricular septum and hypoperfusion at the posterior wall and the apex. On cardiac catheterization, pulmonary capillary wedge pressure, right ventricular, and right atrial pressures were elevated. Coronary angiograms were normal. Myocardial biopsy of the right ventricle histologically revealed epithelioid cell granuloma with infiltration of fibrous cells. The patient's symptom and LV function were improved with conventional medical therapy for heart failure. This is a rare case of cardiac sarcoidosis resulting in biventricular failure.

scholarly journals Cardiac sarcoidosis evaluation and characterization with cardiac magnetic resonance

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
R Caldeira Da Rocha ◽  
B Picarra ◽  
AR Santos ◽  
J Pais ◽  
M Carrington ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Systemic Disease ◽  
Myocardial Edema ◽  
Inferior Wall ◽  
Funding Sources ◽  
Inferior Segment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Sarcoidosis is a multisystemic inflammatory disease, which accounts for substantial morbimortality. Cardiac involvement portends a worse prognosis. A major limitation in the evaluation of cardiac sarcoidosis is that no gold standard clinical diagnostic criteria exists. Cardiac magnetic resonance (CMR) may be indicated in patients with suspected cardiac involvement as a diagnostic and prognostic tool. Purpose The aim of this study was to characterize the features of cardiac involvement of sarcoidosis in patients with stablished diagnosis of the systemic disease, as well as to describe changes observed. Methods A multicenter, 6-years prospective study of all patients with sarcoidosis who performed CMR to evaluate possible cardiac involvement. We followed a protocol to evaluate the left and right ventricles (VE; RV) both anatomically and functionally, T2- weighted STIR sequences to evaluate myocardial edema and presence of late gadolinium enhancement(LGE). Results A total of 20 patients were included. Female patients accounted for 75% of the cases, and the mean age was 53 ± 15 years old. A majority of the patients (90%) had preserved LV (mean LV ejection fraction(EF)63 ± 6%) and RV ejection fraction (mean RV EF 62 ± 7%). Patients observed presented with mean LV end diastolic indexed volume(EDIV) of 72 ± 19 mL/m2 and mean RV EDIV of 63 ± 18mL/m2, with only one patient presenting with LV dilation(LV EDIV 138mL/m2) and two with RV dilation (mean RV EDIV 107 ± 6mL/m2). Possible features of cardiac sarcoidosis were present in 10% (n = 2) of patients. One of them presented with biventricular dilation and severe ejection fraction depression(LV EF 22% and RV EF 28%). LGE was observed in these two patients, with one presenting with an intramyocardial lesion with nodular appearance on the apical inferior segment and the other patient having its distribution characterized with two different patterns: linear appearance on the septal intramyocardium and subepicardial on the basal and mid segments of the inferior wall. On STIR sequences none of the patients presented with hypersignal suggestive of edema. None of them presented with left atrium dilation. Conclusion CMR provides a noninvasive and multidimensional assessment of the heart for evaluation of cardiac sarcoidosis. In our population of patients with sarcoidosis but without established cardiac involvement diagnosis, CMR allowed a 10% increasement on the diagnosis of cardiac sarcoidosis. CMR myocardial fibrosis detection allowed a better stratification of patients with sarcoidosis.

scholarly journals The conundrum of cardiac sarcoidosis 

2019 ◽  
Vol 7 (2) ◽  
pp. 22-25
Author(s):  
Murad Baba ◽  
Luis Dominguez ◽  
Valentin Marian
Keyword(s):  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Electrophysiological Study ◽  
Pulmonary Nodules ◽  
African American Female ◽  
Pericardial Disease ◽  
Systemic Corticosteroids ◽  
Ct Angiogram ◽  
Disease Case ◽  
Life Threatening

Introduction: Sarcoidosis can be a benign, incidentally discovered condition or a life-threatening disorder causing sudden death. The frequency of myocardial involvement is unclear; small registries suggest 5 percent of patients with systemic sarcoidosis, while autopsy studies suggest subclinical cardiac involvement in up to 70 percent. The range of sarcoid involvement of the heart includes heart block and arrhythmias, heart failure, valvular dysfunction, simulated infarction, and pericardial disease. Case Description: 37 year-old African American female with past medical history of presumed asthma presented to the emergency room complaining of progressively worsening dyspnea, chest pain and lightheadedness. Physical examination showed tachycardia with displaced point of maximal impulse (PMI) and minimal rhonchi on right lung base. Laboratory workup did not show any significant results on presentation. Chest X-ray showed bilateral interstitial infiltrates and the chest Computed Tomography (CT) Angiogram showed bilateral scattered pulmonary nodules, right-sided pleural effusion with thickening. Lung biopsy showed non-caseating granulomas typical of sarcoidosis. Further workup revealed Ejection Fraction (EF) of 25% on Transthoracic Echocardiogram (TTE), cardiac catheterization showed normal coronaries and electrophysiological study for inducible arrhythmias was negative. Conclusion: Cardiac sarcoidosis may be suddenly fatal. Therefore, clinicians must maintain a high degree of suspicion for cardiac involvement and screen all patients with extra cardiac sarcoidosis. Despite significant advances in immunosuppressant pharmacotherapy, the backbone of therapy for cardiac sarcoidosis remains systemic corticosteroids.

scholarly journals Recurrent hemopericardium with cardiac tamponade as an initial presentation of cardiac sarcoidosis

2017 ◽  
Vol 5 (1) ◽  
pp. 10
Author(s):  
Aditya Sanjeev Pawaskar ◽  
Gregg M. Lanier ◽  
Priya Prakash ◽  
Julia Y. Ash
Keyword(s):  
Case Report ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Tamponade ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Pulmonary Sarcoidosis ◽  
Non Invasive ◽  
Extra Pulmonary ◽  
Cmr Imaging

This case report illustrates an unusual presentation of recurrent hemopericardium with cardiac tamponade secondary to pulmonary sarcoidosis with extra-pulmonary cardiac involvement. It also demonstrates the usefulness of cardiac magnetic resonance (CMR) imaging as a non-invasive modality for the diagnosis of cardiac sarcoidosis.

scholarly journals Diagnostic Value of Cardiac Magnetic Resonance Strain Analysis for Detection of Cardiac Sarcoidosis

2018 ◽  
Vol 190 (08) ◽  
pp. 712-721 ◽  
Author(s):  
Darius Dabir ◽  
David Meyer ◽  
Daniel Kuetting ◽  
Julian Luetkens ◽  
Rami Homsi ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Circumferential Strain ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Global Longitudinal Strain ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Negative Outcome

Purpose The aim of this study was to investigate the diagnostic value of cardiac magnetic resonance (CMR)-derived strain parameters in patients with sarcoidosis, and to compare results to standard CMR markers of sarcoidosis (edema/T2 ratio, early gadolinium enhancement, late gadolinium enhancement) for prediction of disease outcome. Materials and Methods 61 patients with biopsy-proven sarcoidosis underwent CMR examination. According to CMR results, patients were divided into two different groups: patients with (CMR+; n = 23) and without (CMR–; n = 38) findings consistent with cardiac sarcoidosis. In addition, a group of healthy age-matched volunteers (controls; n = 22) served as controls. Left ventricular functional parameters as well as left ventricular longitudinal and circumferential strain were evaluated in all three groups. Results Compared to controls, global longitudinal strain (GLS) was significantly impaired in patients with sarcoidosis, irrespective of cardiac involvement. No significant differences in GLS could be revealed between CMR+ and CMR– patients. Circumferential strain parameters were significantly impaired in CMR+ patients in comparison to CMR– patients and controls, while no significant differences could be revealed between CMR– patients and controls. GLS was significantly lower in patients with a negative outcome compared to controls. Compared to the rest of the CMR+ and CMR– patients, the GLS in patients with a negative outcome was further reduced but did not reach statistical significance. Conclusion GLS is the only strain parameter detecting left ventricular functional impairment in sarcoidosis patients with otherwise unsuspicious CMR and controls. GLS is further reduced in patients with a negative outcome. Thus, GLS may have the potential to serve as a marker for early cardiac involvement in sarcoidosis. Key points  Citation Format

Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

2021 ◽  
Vol 51 (1) ◽  
pp. 10-15
Author(s):  
Kenneth V Iserson ◽  
Sri Devi Jagjit ◽  
Balram Doodnauth
Keyword(s):  
Aortic Dissection ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Handheld Device ◽  
Thoracic Aortic Dissection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

Q fever: a rare but potentially life-threatening zoonotic disease

2021 ◽  
Vol 14 (2) ◽  
pp. e237155
Author(s):  
Pranav Mahajan ◽  
Kailash Pant ◽  
Shirin Majdizadeh
Keyword(s):  
Chronic Disease ◽  
Cardiovascular System ◽  
Q Fever ◽  
Acute Infection ◽  
Acute Illness ◽  
Unknown Aetiology ◽  
Severe Hepatitis ◽  
The Usa ◽  
Life Threatening ◽  
Acute Q Fever

Q fever can present as a fever of unknown aetiology and can be challenging to diagnose because of the rare incidence. It can present as an acute illness with manifestations, including influenza-like symptoms, hepatitis, pneumonia or chronic disease involving the cardiovascular system. We present a case of a 39-year-old woman in the USA, who developed acute Q fever with associated sepsis and severe hepatitis. She received treatment with recovery from acute infection but currently has symptoms of post Q fever syndrome.

scholarly journals Bladder perivascular epithelioid cell neoplasm: The importance of immunohistochemistry in the diagnosis of an unusual neoplasm

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110008
Author(s):  
Solange De Noon ◽  
Benjamin Ayres ◽  
Uday Patel ◽  
Rami Issa ◽  
Colan Maxwell Ho-Yen
Keyword(s):  
Differential Diagnosis ◽  
Epithelioid Cell ◽  
Review Of The Literature ◽  
Histological Features ◽  
Perivascular Epithelioid Cell Neoplasms ◽  
Perivascular Epithelioid Cell ◽  
Organ Systems ◽  
Cell Neoplasm ◽  
Key Features ◽  
Mesenchymal Tumours

Perivascular epithelioid cell neoplasms represent a group of uncommon mesenchymal tumours with as yet undiscovered benign counterpart. Although perivascular epithelioid cell neoplasms have been described arising in most organ systems as well as in soft tissue and bone, only a small number of perivascular epithelioid cell neoplasms have been reported in the bladder. To date, there is no agreed system for predicting the behaviour of these tumours. We describe a case of a perivascular epithelioid cell neoplasm of the bladder arising in a 57-year-old male and initially diagnosed on biopsy and present a review of the literature focussing on the pathological differential diagnosis and the importance of key histological features in conjunction with a broad immunohistochemical panel. This case report highlights the key features of bladder perivascular epithelioid cell neoplasms that distinguishes these rare neoplasms from other bladder lesions.

scholarly journals POS0886 COULD BE INTERSTITIAL MYOCARDITIS A FEATURE OF THE ANTISYNTHETASE SYNDROME?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 699.1-699
Author(s):  
A. Gil-Vila ◽  
G. Burcet ◽  
A. Anton-Vicente ◽  
D. Gonzalez-Sans ◽  
A. Nuñez-Conde ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Interstitial Lung Disease ◽  
Cardiac Involvement ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Interstitial Tissue ◽  
Antisynthetase Syndrome ◽  
Gadolinium Enhancement

Background:Antisynthetase syndrome (ASS) is characterized by inflammatory myopathy, interstitial lung disease, arthritis, mechanical hands and Raynaud phenomenon, among other features. Recent studies have shown that idiopathic inflammatory myopathies (IIM) may develop cardiac involvement, either ischemic (coronary artery disease) or inflammatory (myocarditis). We wonder if characteristic lung interstitial involvement (interstitial lung disease) that appears in patients with the ASS may also affect the myocardial interstitial tissue. New magnetic resonance mapping techniques could detect subclinical myocardial involvement, mainly as edema (increase extracellular volume in interstitium and extracellular matrix), even in the absence of visible late Gadolinium enhancement (LGE).Objectives:Our aim was to describe the presence of interstitial myocarditis in a group of patients with ASS.Methods:Cross-sectional, observational study performed in a tertiary care center. We included 13 patients diagnosed with ASS (7 male, 53%, mean (SD) age at diagnosis 56,8 years (±11,8)). The patients were consecutively selected from our outpatient myositis clinic. Myositis specific and associated antibodies were performed by means of line immunoblot (EUROIMMUN©). Cardiac magnetic resonance (CMR) was performed on all patients. The study protocol includes functional cine magnetic resonance and standard late gadolinium enhancement (LGE), as well as novel parametric T1 and T2 mapping sequences (modified look locker inversion recovery sequences - MOLLI) with extracellular volume (ECV) calculation 20 minutes after the injection of a gadolinium-based contrast material.Results:CMR could not be performed in one patient due to anxiety. All patients studied (12) had a normal biventricular function, without alteration of segmental contraction. A third (4 out of 12, 33%) of the studied patients showed elevated T2 myocardial values without focal LGE, half of them (2/4) with an elevated ECV, consistent with myocardial edema. Two patients with normal T2 values showed unspecific LGE focal patterns, one in the right ventricle union points and another with mild interventricular septum enhancement (Figure 1). None of the patients studied refer any cardiac symptomatology. All the four patients with T2 mapping alterations (100%) had interstitial lung involvement, but only 4 out of 8 (50%) of the rest ASS patients without T2 mapping positivity. The autoimmune profile was as follows: 10 anti-Jo1/Ro52, 1 anti-EJ/Ro52, 2 anti-PL12.Conclusion:Myocarditis, although subclinical, appears to be a feature in ASS patients. T1 and T2 mapping sequences might be valuable to detect and monitor subclinical cardiac involvement in these patients. The possibility that the same etiopathogenic mechanism may be involved in the interstitial tissue in lung and myocardium is raised. More studies must be done in order to assert the prevalence of myocarditis in ASS.References:[1]Dieval C et al. Myocarditis in Patients With Antisynthetase Syndrome: Prevalence, Presentation, and Outcomes. Medicine (Baltimore). 2015 Jul;94(26):e798.[2]Myhr KA, Pecini R. Management of Myocarditis in Myositis: Diagnosis and Treatment. Curr Rheumatol Rep. 2020 Jul 22; 22:49.[3]Sharma K, Orbai AM, Desai D, Cingolani OH, Halushka MK, Christopher-Stine L, Mammen AL, Wu KC, Zakaria S. Brief report: antisynthetase syndrome-associated myocarditis. J Card Fail. 2014 Dec;20(12):939-45.Figure 1.Cardiac magnetic resonance images from ASS patients.Disclosure of Interests:None declared

scholarly journals A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Salvador Recinos ◽  
Sabrina Barillas ◽  
Alejandra Rodas ◽  
Javier Ardebol
Keyword(s):  
Right Ventricular Dysfunction ◽  
Signs And Symptoms ◽  
Fat Embolism ◽  
Fat Infiltration ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Bone Marrow Harvesting ◽  
Dermatologic Manifestations

Abstract Fat embolism syndrome (FES) is a rare, life-threatening condition habitually associated with traumatic events such as fractures and, less commonly, burns, liposuction and bone marrow harvesting and transplant [ 1]. The biochemical theory for this condition suggests that fat droplets embolize and convert into fatty acids, eventually leading to toxic injury and inflammation, which results in increased vascular permeability, edema and hemorrhage [ 2]. FES may have an asymptomatic interval lasting 12–72 hours after the insult; however, in some cases, signs have also been seen intraoperatively. Pulmonary signs and symptoms are customarily the earliest and manifest in 75% of patients. Nevertheless, neurologic and dermatologic manifestations are also characteristic, and most severe cases could perhaps present with disseminated intravascular coagulation, right ventricular dysfunction, shock or death. The following case consists of a 37-year-old patient that presented with fat embolism syndrome during liposuction and gluteal fat infiltration.

Sign in / Sign up

Export Citation Format

Share Document