PMC4899938_01
32-year-old man with cardiac and pulmonary sarcoidosis (case #1). AP chest x-ray. Note perihilar fullness and bilateral nodular opacities.
gr1.jpg
PMC4899938_01_gr1.jpg
fig1
Chest radiography revealed perihilar fullness and diffuse pulmonary nodular opacities (Fig. 1).
32-year-old man with cardiac and pulmonary sarcoidosis (case #1). Cardiovascular Magnetic Resonance. A. Phase-sensitive inversion recovery (PSIR) 4-chamber view shows patchy areas of near-transmural delayed hyperenhancement in a nonvascular distribution affecting the basal and mid-septum and basal and mid-lateral segments. B T2-weighted turbo spin-echo (TSE) 4-chamber view demonstrates mottled, increased signal intensity in the interventricular septum and lateral wall. C Short-tau inversion recovery (STIR) 4-chamber view demonstrates increased signal intensity at the left ventricular apex consistent with slow flow and heterogeneous signal intensity throughout the interventricular septum and lateral wall.
gr2.jpg
PMC4899938_01_gr2.jpg
fig2
Postgadolinium, phase-sensitive inversion recovery (PSIR) images demonstrated diffuse areas of abnormal delayed hyper-enhancement (DHE) within the left ventricular myocardium in an epicardial/midwall distribution consistent with nonischemic cardiomyopathy (Fig. 2).
32-year-old man with cardiac and pulmonary sarcoidosis (case #1). PET-FDG imaging demonstrates increased activity in the mediastinal and bihilar lymph nodes as well as the heart.
gr3.jpg
PMC4899938_01_gr3.jpg
fig3
Subsequently, positron-emission tomography (PET-FDG) imaging confirmed active disease in the mediastinal lymph nodes and myocardium (Fig. 3).
PMC4899938_02
57-year-old man with cardiac and pulmonary sarcoidosis. Apical 4-chamber transthoracic echocardiogram demonstrates increased right and left ventricular apical thickness.
gr4.jpg
PMC4899938_02_gr4.jpg
fig4
Echocardiography was notable for thickening and increased echogenicity involving the distal half of the left and right ventricles, and mild hypokinesis of the interventricular septum (Fig. 4).
57-year-old man with cardiac and pulmonary sarcoidosis (case #2). Cardiovascular Magnetic Resonance. A, B. Phase-sensitive inversion recovery (PSIR) 4-chamber (left) and Left ventricular Outflow Tract (LVOT) (right) views show diffuse areas of delayed hyperenhancement in a nonvascular distribution affecting the apex, mid, and distal segments of the LV and right ventricular (RV) walls. C. T2-weighted turbo spin-echo (TSE) 4-chamber view demonstrates mottled, increased signal intensity in the interventricular septum and lateral wall. D, E. SSFP images of the chest depict bilateral hilar lymphadenopathy (arrows).
gr5.jpg
PMC4899938_02_gr5.jpg
fig5
CMR revealed diffuse biventricular wall thickening, with associated extensive DHE involving the apex, mid, and distal segments of the LV and right ventricular (RV) walls (Fig. 5A). T2-weighted TSE images showed increased signal in the same segments consistent with active inflammation (Fig. 5B). Hilar and mediastinal lymphadenopathy was also detected on SSFP images of the chest (Figs. 5D, E).
57-year-old man with cardiac and pulmonary sarcoidosis (case #2). Hematoxylin-eosin-stained section of one of several endomyocardial biopsy fragments demonstrates granulomatous infiltration of the myocardium (A, original magnification 40x). Higher magnification of the subendocardial granuloma shows multinucleated giant cells, reactive fibrosis, and absence of caseation necrosis (B, original magnification 400 x).
gr6.jpg
PMC4899938_02_gr6.jpg
fig6
Endomyocardial biopsy of the RV confirmed the suspected MRI diagnosis of sarcoidosis (Fig. 6).