Sundaraiya Sumati, Sulaiman Abubacker, Rajendran Adhithyan
Department of Nuclear Medicine, Apollo Proton Cancer Centre, Tharamani, Tamil Nadu, India.
Department of Radiology, Apollo Proton Cancer Centre, Tharamani, Tamil Nadu, India.
Indian J Radiol Imaging. 2021 Nov 30;31(4):1002-1007. doi: 10.1055/s-0041-1739379. eCollection 2021 Oct.
A young gentleman with suspected cardiac sarcoidosis and LV dysfunction whose CMR revealed multifocal subepicardial to mid myocardial linear enhancement in the left ventricular myocardium underwent cardiac 18F-FDG PET imaging. The images revealed patchy regions of increased FDG uptake involving the apical to mid anterolateral, mid to basal anteroseptal/ right ventricular and mildly increased FDG uptake in apical inferior segments of the LV myocardium concordant with CMR findings. Whole body PET CT imaging showed multiple hypermetabolic supra and infra diaphragmatic lymphadenopathy, with no pulmonary lesion identified. Biopsy from the left para aortic lymph node revealed necrotizing granulomatous inflammation consistent with tuberculosis. Based on the histopathological findings of the lymph nodes, diagnosis of cardiac tuberculosis was made, given the similar imaging appearances in both sarcoidosis and TB. This case highlights that cardiac TB although rare, should be included in the differential diagnosis in patients with suspected infiltrative cardiomyopathy, particularly in TB endemic regions.
一名疑似患有心脏结节病和左心室功能障碍的年轻男性，其心脏磁共振成像（CMR）显示左心室心肌存在多灶性心外膜下至心肌中层线性强化，随后接受了心脏18F-氟代脱氧葡萄糖（FDG）正电子发射断层显像（PET）检查。图像显示，FDG摄取增加的斑片状区域累及心尖至前外侧中部、前间隔/右心室中部至基部，左心室心肌心尖下节段的FDG摄取轻度增加，与CMR结果一致。全身PET-CT成像显示，膈上和膈下多个高代谢淋巴结肿大，未发现肺部病变。左主动脉旁淋巴结活检显示坏死性肉芽肿性炎症，符合结核病表现。基于淋巴结的组织病理学检查结果，鉴于结节病和结核病在影像学表现上相似，故诊断为心脏结核。该病例表明，心脏结核虽罕见，但在疑似浸润性心肌病患者的鉴别诊断中应予以考虑，尤其是在结核病流行地区。
