Cardiac sarcoidosis accompanied by a tumor-like blush on coronary angiography

Abstract

A 71-year-old female was diagnosed with cardiac sarcoidosis by a history of complete atrioventricular block requiring pacemaker implantation and a focal thinning of basal interventricular septum (IVS) on echocardiography. Coronary angiography showed a tumor-like blush fed by septal branch of left anterior descending artery and right coronary artery concomitant with a coronary-to-right ventricle shunt. Echocardiography showed a low echoic mass at mid-IVS with an abnormal shunt flow into right ventricle. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed an uptake at the corresponding site of mid-IVS. Eight months after the initiation of steroid therapy, FDG-PET showed no abnormal uptake at mid-IVS, suggesting decreased activity of cardiac sarcoidosis. We experienced a case of cardiac sarcoidosis with FDG uptake accompanied by a tumor-like blush at mid-IVS. The present case suggests the involvement of microvascular accumulation in the activity of cardiac sarcoidosis. <Learning objective: The detailed mechanism of granuloma formation in patients with sarcoidosis has not been clarified. Although the involvement of microvascular accumulation in the activity of extracardiac granuloma including lung and retina has been reported, the involvement in the activity of cardiac sarcoidosis remains to be elucidated. The present case with a tumor-like blush on coronary angiogram suggests the involvement of microvascular accumulation around the granuloma of cardiac sarcoidosis.>.

Keywords: Cardiac tumor; Corticosteroid therapy; Echocardiography; Neovascularization.

Fig. 1

Cardiac sarcoidosis with a tumor-like blush and abnormal shunt at mid-interventricular septum. (A) Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showing a FDG uptake in mid-interventricular septum (arrow). (B) Right coronary angiography showing a tumor-like blush (arrow) fed by right ventricular branch. (C) Left coronary angiography showing a tumor-like blush (arrow) fed by septal branch. (D) Echocardiography in parasternal long-axis view showing a low-echoic thickening of mid-interventricular septum in end diastolic phase (arrow). A focal thinning of basal interventricular septum was observed (arrowhead). (E) Echocardiography in left ventricular short-axis view showing a shunt flow from mid-interventricular septum into right ventricle in diastolic phase. (F) FDG-PET eight months after the corticosteroid therapy showed no abnormal FDG uptake in mid-interventricular septum (arrow). LV, left ventricle; RV, right ventricle.