Ikeuchi Masaki, Kawano Shunichi, Ando Makoto, Sekiya Masatoshi, Kozai Toshiyuki, Urabe Yoshitoshi, Toyoshima Satoshi
Department of Cardiovascular Medicine, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu-shi 802-0077, Japan.
Department of Internal Medicine, Shin-Kokura Hospital, Kitakyushu, Japan.
J Cardiol Cases. 2011 Aug 20;4(3):e138-e142. doi: 10.1016/j.jccase.2011.07.006. eCollection 2011 Dec.
A 49-year-old woman was referred to our hospital for uncontrollable heart failure. She had never been diagnosed as having sarcoidosis. Chest X-ray showed cardiomegaly without bilateral hilar lymphadenopathy. Echocardiography showed diffuse hypokinesis of the left ventricle mimicking idiopathic dilated cardiomyopathy. No specific manifestations implying sarcoidosis were observed. On cardiac catheterization, coronary angiograms were normal, whereas concurrent routine endomyocardial biopsy showed foci of non-caseating granuloma, indicating sarcoidosis. Pathological finding was the only clue to diagnose cardiac sarcoidosis among our standard examinations for heart failure. No other additional investigations found any extracardiac features of sarcoidosis. All serological and immunological examinations were within normal range. This is a challenging case of biopsy-proven cardiac sarcoidosis without any other extracardiac involvement.
一名49岁女性因无法控制的心力衰竭被转诊至我院。她从未被诊断患有结节病。胸部X光显示心脏扩大，但无双侧肺门淋巴结肿大。超声心动图显示左心室弥漫性运动减弱，类似特发性扩张型心肌病。未观察到提示结节病的特异性表现。心脏导管检查时，冠状动脉造影正常，而同期进行的常规心内膜心肌活检显示非干酪样肉芽肿灶，提示结节病。在我们对心力衰竭的标准检查中，病理结果是诊断心脏结节病的唯一线索。没有其他额外检查发现结节病的任何心脏外特征。所有血清学和免疫学检查均在正常范围内。这是一例经活检证实的心脏结节病且无任何其他心脏外受累的具有挑战性的病例。
