Active Cardiac Sarcoidosis Imitating Cardiac Metastases.

Abstract

A 54-year-old woman diagnosed with sarcoidosis based on mediastinal lymph node biopsy underwent conventional contrast material–enhanced chest CT examination without electrocardiographic synchronization to evaluate pulmonary sarcoidosis. Past medical history included prior left total mastectomy for breast cancer (Fig 1, A). CT results demonstrated multiple hypoattenuating masses involving the septum, free walls of both ventricles, and right atrium (Fig 1, B, C). Cardiac metastases were a potential diagnosis; however, the cardiac lesions were similar in appearance to lymph nodes noted in the hilum and mediastinum. Subsequent late gadolinium enhancement MRI results showed abnormal foci of delayed enhancement in both ventricles and the right atrium, corresponding to the lesions on chest CT (Fig 1, D). Fluorine 18 fluorodeoxyglucose PET results showed abnormal uptake in these areas (maximum standardized uptake value, 12.0) (Fig 1, E). Finally, results of endomyocardial biopsy from the right ventricle revealed a granuloma with lymphocytes, demonstrating active sarcoidosis (Fig 1, F). Open in a separate window A, Contrast-enhanced CT image obtained with a delay time of 90 seconds after contrast medium injection at a slice thickness of 5 mm shows hilar and mediastinal lymphadenopathy (arrows). Note the prior left total mastectomy (arrowheads). B and C, Contrast-enhanced CT images demonstrate hypoattenuating foci in the septum, both ventricles, and right atrium (arrows). D, A four-chamber view of late enhancement MRI acquired 10 minutes after injection of gadolinium-based contrast material reveals delayed gadolinium enhancement in the septum, both ventricles, and right atrium (arrows). E, Abnormal fluorine 18 fluorodeoxyglucose (18F-FDG) uptake is observed in the septum, both ventricles, and right atrium on the 18F-FDG PET image (arrows). F, Endomyocardial biopsy specimen obtained from the right ventricle demonstrates granulomas with giant cells. (CD68 immunohistochemical staining; magnification rate, ×400.)