Cardiac sarcoidosis mimicking left ventricular noncompaction: An approach to acquired apical hypertrabeculation

Abstract

A 65‐year‐old asymptomatic woman, who had been pathologically diagnosed with pulmonary sarcoidosis, was admitted for further evaluation of possible cardiac involvement. Her echocardiography demonstrated the development of apical hypertrabeculation that was not observed 5 years previously. Cardiac magnetic resonance imaging revealed late gadolinium enhancement in the same region. Gallium single photon‐missioned computed tomography/computed tomography revealed high uptake. Therefore, the diagnosis of active cardiac sarcoidosis was established, and subsequent treatment with corticosteroid was initiated. No study regarding acquired left ventricular hypertrabeculation associated with cardiac sarcoidosis has been reported. The integrated multi‐imaging modality approach helped in earlier recognition of cardiac sarcoidosis.

Co-occurrence of Myocardial Sarcoidosis and Left Ventricular Non-compaction in a Patient with Advanced Heart Failure

“…There have been two prior case reports of the co-occurrence of non-compaction and sarcoidosis in patients with cardiomyopathy. [ 1 , 2 ] However, this is the first report to confirm the presence of both disorders by gross pathology and histology.…”

“…Although the cause of systolic dysfunction in LVNC is unclear, there is some evidence suggesting that it may be due to subendocardial hypoperfusion. [ 1 ] Diastolic dysfunction in LVNC is felt to be related to abnormal relaxation secondary to hypertrabeculation. [ 11 ] Imaging studies, such as echocardiography and cardiac MRI, are primarily used to diagnose LVNC, although at present there is no consensus regarding the exact diagnostic criteria.…”

“…Although evidence of concurrent non-compaction and sarcoidosis cardiomyopathy is unusual, one prior case report proposed that active inflammation from sarcoidosis in the trabeculation-rich myocardium may trigger the development of hypertrabeculation. [ 1 ] Another hypothesis is that cardiac involvement of systemic sarcoidosis resulted in end-stage cardiomyopathy. As an adaptation to increased preload and worsening myocardial dysfunction, compensatory biventricular hypertrabeculation may have developed in our patient similar to the acquired LVNC seen in the cohort of heart failure patients.…”

Hypertrabeculation with Infiltrative Features across Multiple Imaging Modalities - A Remnant of Prior Cardiac Sarcoid or Primary Noncompaction Cardiomyopathy

“…While late gadolinium enhancement on cardiac MRI is a well-established feature of cardiac sarcoidosis, it is not typical of the congenital syndrome of non-compaction cardiomyopathy [1]. A single case report of apical hypertrabeculation with active cardiac sarcoidosis has been described with little other literature supporting an association between the two rare conditions [2]. In establishing the diagnostic criteria for non-compaction cardiomyopathy on both echocardiography and MRI, authors have attempted to introduce quantitative criteria for differentiating left ventricular non-compaction from other dilated cardiomyopathies.…”