Multiple involvements of cardiac sarcoidosis in both left and right ventricles and papillary muscles detected by delayed-enhanced magnetic resonance imaging

Clinical significance of papillary muscle late enhancement detected via cardiac magnetic resonance imaging in patients with single old myocardial infarction

“…2) In general, it is accepted that PM-LE indicates that replacement fibrosis seen after PM infarction results from occlusion of one or more feeder arteries. Given that PM-LE has been reported in patients with hypertrophic cardiomyopathy [7], cardiac sarcoidosis [11], and post cardiopulmonary resuscitation [9], PM-LE is not solely related to MI. Development of PM-LE probably results not only from coronary artery occlusion, but also from microcirculation impairment [21] and increased interstitial fibrosis associated with mechanical stress [22] within PMs due to severe LV remodeling.…”

“…Recently, it was reported that late enhancement (LE) of PMs was detected by contrast-enhanced MRI in patients with several types of heart disease [7][8][9][10][11][12][13]. PM-LE is thought to indicate PM necrosis or fibrosis, and has been confirmed to correspond with contractile dysfunction of PMs [8].…”

Clinical Presentation

“…Left ventricular aneurysms develop in patients with extensive involvement of the myocardium. Mitral incompetence may occur with cardiac sarcoidosis due to associated systolic dysfunction and left ventricular dilation or due to papillary muscle involvement by sarcoid granulomas (Sato et al, 2008). Tricuspid regurgitation with atrioventricular block secondary to infiltration of tricuspid valves and conduction system by sarcoid granulomas has been reported as well (Goyal & Aragam, 2006).…”

Vasculitis Presenting with Ventricular Tachycardia

“…Inflammatory disorders that can involve the papillary muscles include sarcoidosis, Takayasu's arteritis, Churg-Strauss, and Wegener's granulomatosis [4][5][6][7][8] . MRI has been shown to be helpful not only in the diagnosis of Churg-Strauss, but also to monitor myocardial response to immunosuppressive therapy 9 .…”