Fujimoto Ryohei, Asano Taku, Maezawa Hideyuki, Shimojima Hisa, Tsujiuchi Miki, Hori Yoshiro, Ebato Mio, Suzuki Hiroshi
Department of Cardiology, Showa University Fujigaoka Hospital.
Department of Radiology, Showa University Fujigaoka Hospital.
Int Heart J. 2018 Nov 28;59(6):1473-1479. doi: 10.1536/ihj.17-713. Epub 2018 Oct 25.
A 52-year-old woman with intermittent complete atrioventricular (AV) block detected on exercise was admitted to the hospital. Echocardiography revealed lesions on the right ventricular side of the interventricular septum and free wall of the basal inferolateral area. Gadolinium-enhanced cardiovascular magnetic resonance (CMR) imaging revealed the mass and wall thickening at the same locations with late gadolinium enhancement (LGE). Focal uptake at the septal lesion was detected using 67Ga scintigraphy. Focal on diffuse intense uptake in the lesions was observed on Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging. Whole-body CT and laboratory evaluations uncovered no signs of malignant tumors in other organs. Ophthalmologic evaluation revealed ophthalmologic sarcoidosis. Although the result of endomyocardial biopsy was negative, the presence of cardiac sarcoidosis was strongly suggested on the basis of the new Japanese guidelines published in 2017. AV conduction disturbance and tracer accumulation on 67Ga scintigraphy completely disappeared after 2 weeks of steroid therapy. The size of mass, inferolateral wall thickness in echocardiography and CMR, and standardized uptake value (SUV) of the masses on 18F-FDG PET also decreased over time.
一名52岁女性因运动时检测出间歇性完全性房室传导阻滞入院。超声心动图显示室间隔右心室侧及基底下外侧区域游离壁有病变。钆增强心血管磁共振成像显示相同部位有肿块及室壁增厚，并伴有钆延迟强化。使用67镓闪烁扫描检测到间隔病变处有局灶性摄取。氟-18氟脱氧葡萄糖正电子发射断层显像显示病变处有局灶性或弥漫性强烈摄取。全身CT及实验室检查未发现其他器官有恶性肿瘤迹象。眼科检查发现有眼部结节病。尽管心内膜活检结果为阴性，但根据2017年发布的日本新指南，强烈提示存在心脏结节病。类固醇治疗2周后，67镓闪烁扫描显示的房室传导障碍及示踪剂摄取完全消失。随着时间推移，超声心动图和磁共振成像显示的肿块大小、下外侧壁厚度以及18F-FDG正电子发射断层显像上肿块的标准化摄取值也降低了。
