LEARN NUCLEAR MEDICINE
Cardiology · Case 08
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 30 year old African American woman with clinical diagnosis of sarcoid who was recently found to have arrhythmias. FDG PET scan below was performed to evaluate for cardiac sarcoid.
Previous
Next
Read the images before opening the teaching panel below.
Active cardiac sarcoid within the anterior wall. Infarct within the septal wall and distal inferior wall.
Imaging Findings
The resting PET perfusion images demonstrate a moderate zone of severely decreased perfusion along the septum and distal inferior wall, and a small zone of mildly decreased perfusion in the mid anterior wall.
The FDG images demonstrate a moderately sized zone of intense FDG uptake along the mid to distal anterior wall.
Disease Process
Multi system disease, cardiomyopathy mostly affects African Americans
Histology: non-caseating Granulomas
Hypercalcemia presentations due to activation of vitamin D in macrophages in granulomas
ACE is elevated
Most patients have pulmonary complications
2% involvement in Cardiac tissue, autopsy 20%= underdiagnosed
Complete heart block in younger patient: Cardiac Sarcoidosis
Signs and Symptoms
Asymptomatic left ventricular dysfunction
Congestive Heart Failure
Atrioventricular Block
Atrial or ventricular arrhythmia
Sudden Death
References
Dubrey, S. W., & Falk, R. H. (2010). Diagnosis and management of cardiac sarcoidosis. Progress in cardiovascular diseases, 52(4), 336-346.
Yamagishi, H., Shirai, N., Takagi, M., Yoshiyama, M., Akioka, K., Takeuchi, K., & Yoshikawa, J. (2003). Identification of cardiac sarcoidosis with 13N-NH3/18F-FDG PET. Journal of nuclear medicine, 44(7), 1030-1036.