https://orcid.org/0000-0002-5691-3744
A 52-year-old man presented with paroxysmal palpitations and lightheadedness for 1 month and was referred to our hospital. The electrocardiogram revealed paroxysmal ventricular tachycardia. The cardiac magnetic resonance (CMR) revealed a space-occupying lesion of the right ventricle near the septal papillary muscle region (Panels A–C and Supplementary material online, Video S1). T2-tirm hyperintensity indicated oedema in the lesion (T2 = 60.3 ms, Panels B and D), and diffuse late gadolinium enhancement (LGE) indicated fibrosis (Panel C). Due to the paroxysmal ventricular tachycardia, the patient was referred for catheter ablation.
Eight months later, the patient came to our hospital again with worsening palpitations and lightheadedness. Electrocardiogram revealed dual-source ventricular tachycardia. The repeated CMR showed the lesion increased from 2.93 to 4.50 cm (Panels E–G) and native T2 was elevated(64.8 ms, Panel H). Positron emission tomography (PET) revealed enhanced glucose metabolism in the lesion yet no extracardiac foci (Panels I–K). The manifestation of the repeated CMR and the abnormal metabolism in PET imaging suggested a malignant cardiac tumour. Surprisingly, however, he was eventually diagnosed with isolated cardiac sarcoidosis (CS) according to the endomyocardial biopsy (Panel L). The patient showing both 18-FDG uptakes on PET scan and positive LGE and elevated T2 on CMR was classified into the inflammatory phase. Finally, we changed the planned catheter ablation to dual-chamber ICD implantation and started immunosuppressive therapy. Now, he had been uneventful during follow-up.
In conclusion, as for cardiac space-occupying lesions in the papillary muscle or cardiac chambers, CS can also be taken into consideration, especially when the isolated CS is progressively enlarged, which can create a diagnostic challenge masquerading as a cardiac mass. Comprehensive application of multimodality imaging can provide cardiac involvement and accurate staging of this kind of tumour-like lesions.
Supplementary data are available at European Heart Journal—Cardiovascular Imaging online.
Funding: Gansu Province Clinical Research Center for Functional and Molecular Imaging (21JR7RA438), Health Industry Research Program Funding Project of Gansu Province (GSWSKY-2019-09).
Data Availability
The raw data will be made available by the authors, without undue reservation.
Author notes
Conflict of interest: The authors have no relationships relevant to the content of the article to disclose.
