Answer for BIR CoW 09 March 2025
Cardiac Sarcoidosis
Findings
TRUFI CINE axial images show relative hypokinesia of right ventricle Delayed post contrast images show hyperenhancement noted along the right ventricular aspect of the interventricular septum at the basal region and RV insertion site. FDG PET images show increased activity in the enlarged mediastinal nodes and in the basal interventricular septum- corresponding to the area of hyperenhancement No perfusion defects seen in the stress images. Features consistent with cardiac sarcoidosis and was proved in transbronchial biopsy of the mediastinal node.
Discussion
Cardiac sarcoidosis (CS) is a high-risk manifestation of sarcoidosis associated with a poor prognosis, as demonstrated by an impaired quality of life and a high risk of death. Cardiovascular magnetic resonance imaging (CMR) is recommended and frequently used for the diagnosis and prognostication of patients with suspected CS Although various patterns of LGE may be seen in patients with cardiac sarcoidosis, findings are usually patchy and multifocal, with sparing of the subendocardium. Typical LGE patterns in patients with cardiac sarcoidosis include subepicardial and midwall LGE along the basal septum, sometimes with extension into the right ventricular insertion points as well as the inferolateral wall. The prognostic value of abnormal FDG appears to be strongest in the presence of a concurrent resting myocardial perfusion defect,which would correspond to the presence of scar visible as LGE on CMR.
Findings
TRUFI CINE axial images show relative hypokinesia of right ventricle Delayed post contrast images show hyperenhancement noted along the right ventricular aspect of the interventricular septum at the basal region and RV insertion site. FDG PET images show increased activity in the enlarged mediastinal nodes and in the basal interventricular septum- corresponding to the area of hyperenhancement No perfusion defects seen in the stress images. Features consistent with cardiac sarcoidosis and was proved in transbronchial biopsy of the mediastinal node.
Discussion
Cardiac sarcoidosis (CS) is a high-risk manifestation of sarcoidosis associated with a poor prognosis, as demonstrated by an impaired quality of life and a high risk of death. Cardiovascular magnetic resonance imaging (CMR) is recommended and frequently used for the diagnosis and prognostication of patients with suspected CS Although various patterns of LGE may be seen in patients with cardiac sarcoidosis, findings are usually patchy and multifocal, with sparing of the subendocardium. Typical LGE patterns in patients with cardiac sarcoidosis include subepicardial and midwall LGE along the basal septum, sometimes with extension into the right ventricular insertion points as well as the inferolateral wall. The prognostic value of abnormal FDG appears to be strongest in the presence of a concurrent resting myocardial perfusion defect,which would correspond to the presence of scar visible as LGE on CMR.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!