A Rare Case Report of Cardiac Sarcoidosis with Pulmonary Hypertension

Abstract

Introduction: Cardiac sarcoidosis (CS) is a rare granulomatous disorder in which white blood cells form clusters on the myocardium. The clinical presentations of CS are varied, as is its etiology. Multiple diagnostic approaches to determine the cause of persistent dyspnea may fail, as cardiac sarcoidosis can mimic many other diseases.
Case Report: A 47-year-old woman presented with a sudden onset of dyspnea and a history of chronic thrombo-embolic pulmonary hypertension (CTEPH). Multiple diagnostic approaches were employed, including a CT scan of the thorax with contrast, CT pulmonary angiography, CT coronary angiography, and a Ventilation/Perfusion test, but the results were inconclusive. A Cardiac MRI was ultimately performed, which led to a diagnosis of cardiac sarcoidosis.
Case Discussion: The patient had been stable and asymptomatic over the years, despite her history of CTEPH, until she developed a sudden onset of dyspnea. The presence of pitting edema, ECG results, and echocardiography data initially suggested a diagnosis of congestive heart failure. However, tests from the pulmonary system and cardiac coronary were normal. This highlights the elusive nature of cardiac sarcoidosis, which can often go unnoticed and be frequently misdiagnosed. Given the inconclusive results from previous tests, a Cardiac MRI was performed to further characterize the pathology. This led to the findings of Late Gadolinium Enhancement (LGE) and the diagnosis of CS.
Conclusion: Cardiac sarcoidosis is a master imitator of many diseases, with patients sometimes presenting with only dyspnea. In such cases, Cardiac MRI plays a pivotal role as a diagnostic test, especially when results from other diagnostic workups are nonspecific.