A case of cardiac sarcoidosis masquerading as arrhythmogenic right ventricular cardiomyopathy awaiting heart transplant

SummaryWe report a case of 45-year-old man, who was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC) and presented with right ventricular (RV) enlargement with a global decrease in RV contractility accompanied by impairment of left ventricular function. He was placed on the heart transplant waiting list. Endomyocardial biopsy from RV septal wall did not show any evidence of sarcoidosis or inflammatory change. Four years after he was put on the heart transplant waiting list, a computed tomography chest scan for the purpose of anatomical evaluation for coronary sinus prior to biventricular pacing lead implantation incidentally showed bilateral hilar lymphadenopathy, which suggested the possibility of sarcoidosis. Biopsy of the inguinal lymph node pathologically was consistent with sarcoidosis. The 2[18F]fluoro-2-deoxy-d-glucose positron emission tomography scanning (FDG-PET) demonstrated intense uptake in the myocardium, and the patient was finally diagnosed as having cardiac sarcoidosis. After steroid treatment, the abnormal FDG-PET uptake disappeared. The patient therefore represented a case of cardiac sarcoidosis masquerading as ARVC. It should be recognized that RV involvement is one of the manifestations in cardiac sarcoidosis

クリカエス シンフゼン ト イジ トウセキ ドウニュウ カラ リダツシエタ ジンドウミャク キョウサクショウ ノ イチレイ

A ７２-year-old woman with chronic renal failure and hypertension was admitted to Tokushima University Hospital due to progressive dyspnea. The patient had a history of right nephrectomy for renal tubular carcinoma two years before admission. The patient was diagnosed as acute left ventricular decompensation with pulmonary edema, and dyspnea was improved by means of mechanical ventilation. Although diuretics and antihypertensive agent were given intensively, acute pulmonary edema easily recurred with deterioration of renal function, and continuous hemodiafiltration（ CHDF）was required. Abdominal ultrasound showed marked increase of blood flow velocity of left renal artery, suggesting renal artery stenosis. Renal angiography with ultrasound guidance revealed narrowing of left renal artery ostia, and percutaneous transluminal renal angioplasty（ PTRA）with stenting placement was performed. Renal dysfunction and blood pressure control were improved immediately after PTRA, and the patient became asymptomatic