Identification of left ventricular chamber-like aneurysm related to cardiac sarcoidosis

Description

A 58-year-old woman was referred to us with an abnormal ECG, showing complete right bundle branch block and left anterior fascicular block. An echocardiogram showed left ventricular (LV) septal thinning and hinted at the presence of an LV aneurysm. An enhanced CT indeed revealed an LV aneurysm-like structure. After appropriate testing to exclude coronary artery disease, this LV anomaly led us to suspect the possibility of cardiac sarcoidosis (CS). Cine cardiac magnetic resonance (CMR) imaging showed an apparent chamber-like aneurysm, and late gadolinium enhancement (LGE) CMR showed transmural positive enhancement in the mid-portion of the LV at the region of the aneurysm (figure 1A,B). As our institution lacked an FDG-PET scanner, gallium scintigraphy was instead performed, which showed uptake in the heart and bilateral hilar lymph nodes (figure 2A,B); hilar lymphadenopathy was undetected on enhanced CT, and its presence strongly indicated sarcoidosis. We finally made...

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