Author + information
- Received September 22, 2012
- Accepted October 25, 2012
- Published online April 9, 2013.
A 55-year-old African American woman was admitted to our institution after a syncopal episode while at rest. Echocardiography showed anterior and anteroseptal mid-basal wall hypertrophy with an associated wall motion abnormality. The results of dipyridamole myocardial perfusion imaging were negative. Computed tomography of the chest revealed a slightly enlarged anterior mediastinal lymph node. Cardiac magnetic resonance showed normal biventricular systolic function and increased thickness of the left ventricular mid-basal anterior and anteroseptal walls (A and Online Video 1, cine steady-state free precession short-axis view). Delayed-enhancement cardiovascular magnetic resonance revealed transmural hyperenhancement of the mid-basal anterior, anteroseptal, and right ventricular free walls suggestive of cardiac sarcoidosis (B, short axis view; C, 2-chamber view). Excisional biopsy of the anterior mediastinal lymph node confirmed the diagnosis (D, Fibrosis is evident in the left upper quadrant; multiple non-caseating granulomas are seen in the right upper and lower quadrants; no evidence of acid-fast bacilli or fungus are noted on the special stains. (E) A magnified view shows multiple non-caseating granulomas, white arrows, and multinucleate giant cells, black arrows). High-dose oral steroid therapy was initiated, and the patient was discharged on a slow taper. At 3-month follow-up, the patient remained asymptomatic, and repeat delayed-enhancement cardiac magnetic resonance showed a significantly decreased extent of hyperenhancement in the same territories (F, short-axis view; G, 2-chamber view).
- Received September 22, 2012.
- Accepted October 25, 2012.
- American College of Cardiology Foundation