Case Session 02: Non-ischemic Cardiomyopathies (2018)-Unexplained arrhythmias: the fine line between cardiac sarcoidosis and arrhythmogenic cardiomyopathy.

Unexplained arrhythmias: the fine line between cardiac sarcoidosis and arrhythmogenic cardiomyopathy.

Video Transcription

Video Summary

A previously healthy 46-year-old man presented with palpitations and frequent ventricular arrhythmias. Echo, CMR, and nuclear imaging showed regional ventricular abnormalities and non-ischemic late gadolinium enhancement, but coronary arteries were normal and endomyocardial biopsy was inconclusive. Although initial tests for other causes were negative, chest CT suggested possible sarcoidosis. A hybrid PET-MR scan showed matching myocardial inflammation and injury, plus FDG-avid lymph nodes. Biopsy of a lymph node confirmed non-necrotizing granulomatous sarcoidosis, establishing active cardiac sarcoidosis with predominant cardiac involvement. Corticosteroid therapy was started. The case highlights the value of hybrid PET-MR for diagnosis and disease activity assessment.

Keywords

cardiac sarcoidosis

PET-MR

ventricular arrhythmias

myocardial inflammation

granulomatous disease