PMC5412658_01
Twelve-lead electrocardiography (ECG). A: ECG during sinus rhythm on admission. B: ECG during ventricular tachycardias (VTs). Two QRS morphologies of VTs in the 12-lead ECG were observed; 1 VT exhibited a QRS complex having a right bundle branch block-type morphology and the other exhibited a left bundle branch block-type morphology.
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The 12-lead electrocardiograms during sinus rhythm and VTs are shown in Figure 1. The 12-lead electrocardiogram during sinus rhythm showed a first-degree atrioventricular block and right bundle branch block (Figure 1A). Two VTs were observed after admission to our hospital (Figure 1B); VTs were suppressed by a combination therapy of antiarrhythmic drugs (amiodarone 200 mg, carvedilol 5 mg, and mexiletine 300 mg).
Cardiac magnetic resonance imaging (MRI). A: Cardiac MRI showing myocardial inflammation and edema. B: Late gadolinium enhancement was confirmed to match the intracardiac mass (red arrows).
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Cardiac MRI confirmed myocardial edema evidenced by increased signal intensity on T2-weighted images, and late gadolinium enhancement was confirmed to match the intracardiac mass in the ventricular septum and inferior wall (Figure 2).
Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) / computed tomography (CT) and spinal magnetic resonance imaging (MRI) obtained before and after corticosteroid treatment and the implantation of a cardiac resynchronization therapy defibrillator (CRT-D) (the left panel in each figure shows sagittal view, and the right panel shows transaxial view). A: Abnormal uptake of 18F-FDG was registered in the heart and cervical spinal canal before treatment (white arrows). B: Gadolinium-enhanced MRI showed a cervical extradural lesion with high signal intensity at the C5 -7 level (red arrow). C: Follow-up 18F-FDG PET/CT showed a disappearance of abnormal 18F-FDG uptake in the heart and cervical spinal canal 5 months after treatment. D: The follow-up MRI 5 months after treatment showing a further decline of the epidural lesion. Very clear images were obtained despite CRT-D implantation.
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Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography / computed tomography revealed a strong 18F-FDG uptake in the myocardium as focal or diffuse pattern and in the cervical spinal canal (Figure 3A). Although the patient had no neurologic symptoms, spinal gadolinium-enhanced MRI showed a focal extradural lesion with high signal intensity at the C5-7 level (Figure 3B). After implantation of the CRT-D, prednisolone (30 mg) was administered daily. 18F-FDG positron emission tomography / computed tomography was performed to evaluate the corticosteroid treatment after 5 months; abnormal uptake of FDG at heart and spine completely disappeared (Figure 3C). Spinal MRI was performed to evaluate the cervical extradural lesion at the C5-7 level; however, it had completely disappeared (Figure 3D).