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International journal of cardiology 02/2013; · 7.08 Impact Factor
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ABSTRACT: An asymptomatic 62-year-old female patient with sarcoidosis was referred to our hospital for new-onset right bundle-branch block by electrocardiogram (ECG). She had been diagnosed with sarcoidosis by lymph node biopsy 3 years previously, and followed up by chest X-ray and ECG from then onward. Chest X-ray on admission showed bilateral lymph node enlargement, which was unchanged. Transthoracic echocardiogram showed wall thinning and severe hypokinesis in the basal portion of the left ventricular (LV) posterior-inferior wall, and coronary heart disease was excluded by conventional coronary angiogram. ECG-gated enhanced 320 slice multislice computed tomography revealed contrast defects in the basal portion of the LV posterior-inferior wall with reduced wall thickness in the early phase, which were conversely abnormally enhanced in the late phase, suggesting fibrosis or edema with inflammation. Late gadolinium enhancement in contrast-enhanced magnetic resonance imaging (MRI) was observed in the same region. To evaluate for evidence of inflammation, we performed 67-gallium-citrate scintigraphy, T2-weighted MRI, and fasting 18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET). Although the 67-Ga scintigram showed no significant uptake, T2-weighted MRI revealed high intensity images, and fasting 18F-FDG PET identified increased uptake of FDG in the basal portion of the LV posterior-inferior wall, suggesting inflammation. We started corticosteroid therapy, diagnosing her condition as active cardiac sarcoidosis.
International journal of cardiology 07/2011; 150(2):e81-4. · 7.08 Impact Factor
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Seitaro Nomura,
Nobusada Funabashi,
Yukari Sekiguchi,
Saeko Masuda,
Satoshi Kuwabara,
Sonoko Misawa, Michiko Daimon,
Masae Uehara,
Hideyuki Miyaiuchi,
Issei Komuro,
Yoshio Kobayashi
International journal of cardiology 06/2011; 150(2):213-6. · 7.08 Impact Factor
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ABSTRACT: We performed segment by segment analysis for comprehensive evaluation of the characteristics of the left ventricular (LV) myocardium by multislice CT (MSCT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET) in a patient with non-coronary arterial cardiac dysfunction. If diagnosis had been performed only by transthoracic echocardiogram and conventional coronary angiography, this subject might have been diagnosed as having dilated cardiomyopathy. However, we succeeded in the detailed evaluation of characteristics of LV myocardium non-invasively. Because of the difference in spatial resolution, MSCT and MRI could only detect focal fibrosis and MSCT could only detect fatty changes in the LV myocardium with an accurate ratio of thickness of lesions in comparison with the thickness of the whole LV myocardium. Conversely, a drawback of PET and SPECT was the partial volume effect and these methods could visualize the lesions as only diffuse decrements of attenuation and could not provide detailed information. Furthermore in MSCT, LV wall motion abnormality could be visualized by showing the ribs, sternum and descending aorta and in particular MSCT could obtain much information, including extra cardiac findings.
International journal of cardiology 07/2009; 145(1):95-100. · 7.08 Impact Factor
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Koki Nakamura,
Nobusada Funabashi,
Hideyuki Miyauchi,
Mari Aminaka,
Masae Uehara,
Marehiko Ueda,
Taichi Murayama,
Yasuhiko Hori,
Takashi Nakayama, Michiko Daimon,
Nakabumi Kuroda,
Yoshio Kobayashi,
Issei Komuro
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ABSTRACT: We report the case of a 38-year-old Asian man with a pericardial hemangioma on the left main coronary artery. The patient presented initially at our hospital after cardiopulmonary resuscitation following an episode of ventricular fibrillation (VF). Because of spontaneous coved-type ST segment elevation on the higher intercostal space V1 to V2 in a 12-lead electrocardiogram, documented VF in the absence of structural heart disease, and a family history of sudden death, he was diagnosed with Brugada syndrome. Transesophageal echocardiography showed a smooth-surfaced mass with well-demarcated borders, directly above the left main coronary artery. Computed tomography confirmed the presence of the mass, which showed no enhancement at early phase, but did demonstrate homogenous enhancement at delay phase by contrast material. There were no findings from either the nuclear medicine or the tumor marker investigations which indicated that the mass located just above the main coronary arteries was malignant. Therefore, taken together, these findings suggested that the tumor might be a pericardial hemangioma. The relationship between the location of the hemangioma just above the left main coronary artery and the occurrence of VF was not clear, i.e. whether the presence of the hemangioma caused the stimulation of the left main coronary artery and as a result, led to the spasm of the left main coronary artery and the occurrence of VF. Furthermore, as the tumor did not extend into any of the adjacent structures, such as the coronary arteries or the right ventricular outflow tract, surgical resection was not performed; instead, the patient received a dual chamber implantable cardioverter-defibrillator.
International journal of cardiology 08/2008; 127(3):437-41. · 7.08 Impact Factor
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ABSTRACT: Chronic active Epstein-Barr virus (CAEBV) infection is characterized by chronic or recurrent infectious mononucleosis-like symptoms and the prognosis of CAEBV infection is quite poor. The incidence of myocarditis as a complication of EBV infection is not so high and it is unusual that heart failure appears as the initial symptom. However, it is very important to detect and treat chronic active myocarditis in the early phase of CAEBV infection because chronic active myocarditis disorganizes and decreases cardiomyocytes, resulting in the progression to heart failure. We report a case of a 45-year-old man with CAEBV infection for 5 years. Echocardiography revealed moderate left ventricular systolic dysfunction with mild pericardial effusion. Endomyocardial biopsies demonstrated massive lymphocytic infiltration with adjacent myocytolysis and necrosis of cardiomyocytes suggesting active myocarditis. Immunohistological analysis of biopsies revealed that the infiltrating cells were mainly T lymphocytes. And some of the infiltrating cells showed a positive signal for the EBV-encoded small nuclear RNA by in situ hybridization. Positron emission tomography using (18)F-fluoro-2-deoxyglucose ((18)F-FDG) performed revealed increased uptake of (18)F-FDG of whole left ventricular wall with mild heterogeneity.
International journal of cardiology 11/2007; 130(1):e11-3. · 7.08 Impact Factor
