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|Number 10-11 Cardiac Sarcoidosis - CMR assessment in the Acute Phase and At Follow-Up|
Number 10-11 Cardiac Sarcoidosis - CMR assessment in the Acute Phase and At Follow-Up
Case from: Florian von Knobelsdorff-Brenkenhoff, Jeanette Schulz-Menger
Clinical history: A 32-year-old man presented with chest pain, fever, erythema nodosum of the lower extremities and swelling of both ankles. ECG showed ST-elevation in leads I and aVL (Image 1) associated with a troponin rise (up to 40-fold).
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Urgent coronary angiogram ruled out coronary artery disease (Movies 1 & 2), but revealed regional wall motion abnormalities anteriorly, and possibly apically (Movie 3). CMR was requested to further investigate the nature of the regional wall motion abnormality.
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Cine CMR: standard SSFP cine images showed mildly impaired LV systolic function with hypokinesia of the anterior, lateral and inferior walls. A small pericardial effusion was also noted (Movies 4 & 5).
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T2-weighted imaging revealed increased signal intensity suggestive of myocardial oedema of the anterior wall (Images 2 & 3, double white arrows).
The patient was consequently started on steroids and completely recovered from a clinical point of view. A repeated CMR was performed after 2 months.
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Cine CMR after (2-month follow-up): Standard SSFP cines showed complete resolution of the previously noticed regional wall motion abnormalities, and a restored LV ejection fraction (Movie 6 & 7).
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T2-weighted imaging (2-month follow-up) demonstrated normal myocardial signal intensity, confirming the absence of myocardial oedema (Image 8).
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