Cardiac sarcoidosis : A cause of infiltrative cardiomyopathy CARDIOVASCULAR BOARD REVIEW

Physical examination Vital signs: temperature 36.9 ̊C (98.4 ̊F), blood pressure 142/86 mm Hg, pulse 90, respiratory rate 20. Cardiac examination: regular rate and rhythm, no murmurs, gallops, rubs, or jugular venous distention. Chest: clear to auscultation without rhonchi or rales. Diagnostic tests Chest radiograph: mild bilateral hilar prominence and mild apical infiltrates (FIGURE 2). Right and left cardiac catheterization: mild diffuse disease, 50% focal stenosis of the distal left anterior descending artery, ejection fraction 30%. Cine magnetic resonance imaging (to evaluate right ventricular dysplasia): normal. Electrophysiologic study: easily inducible rapid ventricular tachycardia without focal lesion that can be ablated. Computed tomography of the chest with contrast: bilateral hilar adenopathy with carinal and mediastinal adenopathy, diffuse interstitial infiltrates throughout both lungs (FIGURE 3). Pulmonary function tests: mild restrictive pattern. Purified protein derivative (tuberculin) and anergy panels: normal. Bronchoscopy with biopsy and bacterial cultures: non-necrotizing granulomas, no infectious etiology identified. The diagnosis of sarcoidosis is considered. A CURTIS M. RIMMERMAN, MD Head, Section of Clinical Cardiology, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation WAEL A. JABER, MD Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation