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Number 07-15. Sarcoidosis Masquerading as ARVD/C

Case from: John Petersen, Carsten Schmalfuss, Pat Mergo, Gary R. Cooper, CMR Service, University of Florida, Gainesville, FL. USA

Clinical history: A 46 year old African American presenting with VT of LBBB morphology
CXR: Diffuse parenchymal disease
ECG: Normal
Angiography and Echo: Normal
CT: areas of ground glass opacity, interlobular septal thickening and hilar adenopathy consistent with pulmonary sarcoidosis
Transbroncheal lymph node Biopsy: non-caseating granulomas.
CMR referral: To confirm suspicion of cardiac sarcoidosis despite normal echocardiography
CMR cine: Thinned, dyskinetic RV inferior wall/apex EF 42%
CMR late enhancement: Matching LGE (plus a small area in the IVS)
Interpretation: Without the clinical history the RV findings would have suggested ARVC/D. A better interpretation here is that the changes represent a less common variant of cardiac sarcoidosis affecting solely the RV. Cardiac sarcoidosis histopathology causes non-caseating granulomas and fibrosis, the fibrosis here visualised by LGE.

References:
Ott et al: Cardiac sarcoidosis masquerading as ARVD.Pacing Clin Electrophysiol. 2003;26:1498-503.
Shiraishi J et al: Cardiac sarcoidosis mimicking right ventricular dysplasia. Circ J. 2003 Feb;67(2):169-71

Scanner: Siemens Sonata

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