PMC9613964_01
The first and second cardiac magnetic resonance show abnormal signals and LGE in the right ventricular surface of the ventricular septum. And the second time LGE was more severe than the first time.
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F1
Cardiac magnetic resonance (CMR) imaging revealed abnormal signals in the right ventricular surface of the ventricular septum, and late gadolinium enhancement (LGE) (Figure 1). In local hospital repeat CMR imaging showed that LGE was aggravated (Figure 1).
FDG-PET reveals intense multifocal cardiac uptake in the interventricular septum and right ventricle, and no abnormal lesions are found in other parts of the body. FDG-PET, Fluorine-18 fluorodeoxyglucose positron emission tomography.
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F2
Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated intense multifocal cardiac uptake in the interventricular septum and right ventricle without abnormal lesions in other parts of the body (Figure 2).
The last cardiac magnetic resonance is used for accurately locating the lesion and improving the success rate of the endomyocardial biopsy. Images show abnormal signals in the right ventricular surface of the ventricular septum, and significant LGE.
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F3
To accurately locate the lesion and improve the success rate of the EMB, the patient underwent the last CMR (Figure 3).
A large number of epithelioid nodules composed of epithelioid cells, multinucleated giant cells [A,B (green arrow)], and lymphocytes are found in the myocardium and endocardium.
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F4
However, no necrotic tissue was found on acid-fast staining (-) (Figure 4).
FDG-PET showed that the area of increased glucose metabolism in the original lesion was reduced, indicating the effectiveness of immunosuppressive therapy.
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F5
FDG-PET showed that the area of increased glucose metabolism in the original lesion was reduced, indicating the effectiveness of immunosuppressive therapy (Figure 5).