3 T MRI CARDIAC

CARDIAC SARCOIDOSIS

FINDINGS:

• Mildly dilated left ventricle showing severe global hypokinesia with regional wall motion abnormalities and resultant severely reduced systolic function.
• Patchy linear & nodular areas of mid-myocardial & sub-epicardial late gadolinium enhancement and myocardial edema of left ventricle. Percentage of enhancing myocardium = 7 %
• Moderately dilated left atrium.
• Mild aortic regurgitation.
• Moderate to severe mitral regurgitation.
• Mild pulmonary regurgitation.

Above-described features are s/o Inflammatory Myocarditis. Possibilities include

Granulomatous Cardiomyopathy like Cardiac Sarcoidosis (CS).

DISCUSSION:

• Sarcoidosis is a multisystem disorder with unknown etiology that is characterized by the presence of noncaseating, nonnecrotic granulomas in the involved organs.
• Cardiac involvement of sarcoidosis is a manifestation of sarcoidosis which is often asymptomatic, associated with high mortality. 
• Autopsy studies show prevalence of ~25% cardiac involvement, yet only 5-10% are found symptomatic. 
• Up to 33% of sarcoidosis may manifest as isolated cardiac involvement.
• Most cases of autopsy-proven cardiac sarcoidosis are not clinically symptomatic.
• Symptomatic cardiac sarcoidosis often presents with severe cardiac derangement and is the primary manifestation of sarcoidosis in these patients.
• Symptomatic cardiac sarcoidosis has a nonspecific presentation like; arrhythmias, heart block, syncope, congestive cardiac failure, ventricular aneurysm formation.
• Positive findings without clinical correlate are thought to potentially represent subclinical disease.
• CS remains a diagnostic challenge. Timely recognition of CS is essential but difficult because of nonspecific clinical manifestations and imaging features that overlap with those of other inflammatory and infiltrative cardiac disorders.

Cardiac MRI may help further characterize the type as well as help in management and risk stratification.

3.0 T · MRI 3.0 MRI