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1.
BMJ Case Rep ; 14(4)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33811092

RESUMO

A 66-year-old man with pulmonary sarcoidosis was referred to the urology team for assessment of troublesome lower urinary tract symptoms. An elevated blood serum prostate-specific antigen raised concern for prostate cancer. An MRI of the prostate demonstrated a potentially aggressive prostate lesion, along with low T1 signal skeletal lesions, suggestive of metastatic disease. Subsequent bone scan and MRI whole spine demonstrated further skeletal lesions. In cases of known prostate cancer, sometimes a presumptive diagnosis of skeletal metastases is made without histological diagnosis from the skeletal lesions. However, there were certain factors in this case whereby skeletal biopsy was deemed prudent prior to further therapy. Factors included atypical MRI signal characteristics for metastatic disease, absence of a positive tissue diagnosis from the prostate and the clinical background of sarcoidosis. The biopsy confirmed skeletal sarcoid rather than metastatic disease, thereby avoiding inappropriate and potentially toxic treatment for the patient.


Assuntos
Neoplasias da Próstata , Sarcoidose , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias da Próstata/diagnóstico , Cintilografia , Sarcoidose/diagnóstico por imagem , Crânio
2.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(1): 53-56, 2021 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-33663663

RESUMO

Objective To compare the differences of energy spectrum CT between small cell lung cancer(SCLC)with mediastinal lymph node metastasis and mediastinal sarcoidosis.Methods Twenty-five SCLC patients with mediastinal lymph node metastasis(SCLC group)and 26 patients with mediastinal sarcoidosis(sarcoidosis group)confirmed by bronchoscopy and biopsy in Tangshan People's Hospital from January 2018 to June 2019 were selected as the research objects.The CT value,iodine concentration,water concentration and energy spectrum curve slope under different single energy levels were compared between SCLC group and sarcoidosis group.Results The single-energy CT values of 40-80 keV segments in the arterial phase of the SCLC group were significantly higher than those in the sarcoidosis group(all P <0.05).The single-energy CT values of 90-140 keV segments were not significantly different from those in the sarcoidosis group(all P >0.05).The single-energy CT values of 40-90 keV segments in venous phase of the SCLC group were significantly higher than those of the sarcoidosis group(all P <0.05),and the single-energy CT values of 100-140 keV segments were not significantly different from those of the sarcoidosis group(all P >0.05).The concentrations of iodine in the arterial phase and venous phase of the SCLC group were(11.56±4.06)µg/cm 3 and(13.39±0.87)µg/cm 3,respectively,which were significantly higher than those [(4.43±3.85)µg/cm 3,t=11.564,P=0.026;(7.23±2.71)µg/cm 3,t=13.653,P=0.021] in the sarcoidosis group.The concentrations of water in the arterial and venous phases of the SCLC group were(1040.67±5.62)mg/cm 3 and(1035.23±8.57)mg/cm 3,respectively,which showed no statistically significant difference compared with those [(1028.87±6.94)mg/cm 3,t=3.155,P=1.861;(1021.53±4.68)mg/cm 3,t=3.265,P=1.687] in the sarcoidosis group.The slopes of energy spectrum curve at 40-70 keV,70-100 keV and 100-140 keV in venous phase of the SCLC group were significantly higher than those of the sarcoidosis group(all P <0.05),whereas they showed no significant difference between the two groups in arterial phase(all P >0.05).Conclusion The differences between SCLC with mediastinal lymph node metastasis and mediastinal sarcoidosis can be shown on the single-energy CT values of 40-80 keV in arterial phase and 40-90 keV in venous phase,iodine concentrations in arterial phase and venous phase,and the slope of energy spectrum curve in venous phase.


Assuntos
Neoplasias Pulmonares , Sarcoidose , Carcinoma de Pequenas Células do Pulmão , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Linfonodos , Metástase Linfática , Sarcoidose/diagnóstico por imagem , Carcinoma de Pequenas Células do Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Medicine (Baltimore) ; 100(6): e24027, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578518

RESUMO

RATIONALE: Sarcoidosis is a multisystem granulomatous disease with unknown etiology. It affects mainly the lungs, but it can affect almost any other organ. Nevertheless, pleural involvement with the development of pleural effusion is relatively rare. It is usually mild and responsive to treatment with systemic steroids. Here we present a case of rapidly recurring massive unilateral pleural effusion caused by sarcoidosis that was resistant to systemic steroids. PATIENT CONCERNS: A 55-year-old lady presented with shortness of breath of 2-months duration. No other respiratory symptoms were reported. On physical examination, there were signs of left-sided pleural effusion, splenomegaly, and inguinal lymph nodes. These findings were confirmed by chest x-ray showing massive pleural effusion. Work up of the effusion revealed an exudative effusion with lymphocyte predominance. Pan-computed tomography scan revealed multiple thoracic, abdominal and inguinal lymphadenopathy; additionally, a left-sided pleural effusion and an enlarged spleen; that contained variable hypodense nodular lesions. Positron emission tomography-computed tomography showed intense uptake in the spleen and the lymph nodes. Inguinal lymph node biopsy showed non-necrotizing granulomatous inflammation. Due to suspicion of malignancy, left medical thoracoscopy was done, and biopsy of the parietal pleura showed nonspecific inflammation without evidence of malignancy or tuberculosis. DIAGNOSIS: Sarcoidosis was diagnosed based on the finding of the non-necrotizing granulomatous inflammation with no evidence of malignancy or infection on several microbiological and pathological samples. INTERVENTIONS: The patient was treated with repeated pleural fluid drainage. Steroids failed to prevent pleural effusion recurrence. Surgical left side pleurodesis was eventually performed. OUTCOMES: At more than 1 year follow up, the patient showed no recurrence of pleural effusion or development of any other symptoms. LESSONS: Sarcoidosis may rarely present with massive pleural effusion, as this presentation is rare; it is imperative to rule out other causes of massive pleural effusion. Massive pleural effusion in sarcoidosis may be steroid-resistant. Pleurodesis may have a role in such a scenario.


Assuntos
Derrame Pleural/etiologia , Sarcoidose/complicações , Sarcoidose/patologia , Biópsia , Drenagem/métodos , Dispneia/etiologia , Exsudatos e Transudatos/citologia , Feminino , Humanos , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Linfadenopatia/patologia , Pessoa de Meia-Idade , Pleura/cirurgia , Derrame Pleural/cirurgia , Pleurodese/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Radiografia Torácica/métodos , Recidiva , Sarcoidose/diagnóstico por imagem , Toracoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558377

RESUMO

A 43-year-old African American man presented with right upper quadrant pain and elevated blood pressure. Investigations revealed elevated lipase, hypercalcaemia and elevated creatinine. CT abdomen with contrast revealed extensive intraabdominal lymphadenopathy with an initial suspicion for a lymphoproliferative malignancy. Patient was managed for acute pancreatitis, with further workup of hypercalcaemia revealing an elevated ACE level. Inguinal lymph node biopsy confirmed a non-caseating granuloma leading to the diagnosis of sarcoidosis.


Assuntos
Pancreatopatias/diagnóstico , Pancreatite/etiologia , Sarcoidose/diagnóstico , Lesão Renal Aguda/etiologia , Corticosteroides/uso terapêutico , Adulto , Biópsia , Creatinina/sangue , Diagnóstico Diferencial , Humanos , Hipercalcemia/etiologia , Lipase/sangue , Linfonodos/patologia , Masculino , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/tratamento farmacológico , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Tomografia Computadorizada por Raios X
7.
Int Heart J ; 62(1): 201-206, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455993

RESUMO

The definite diagnosis of cardiac sarcoidosis (CS) can be difficult because it mimics other cardiomyopathies and morphological abnormalities during its time course. Distinguishing CS isolated cardiac sarcoidosis from other cardiomyopathies is very important for the introduction of immunosuppressive therapy.In this study, we report a patient who had initially been diagnosed with hypertrophic obstructive cardiomyopathy (HOCM). The patient developed complete atrioventricular block (CAVB) and morphological abnormalities, which led to his primary diagnosis being re-conducted. Moreover, we made a definite diagnose of isolated CS (ICS) based on the guideline for the diagnosis and treatment using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT)1) and performed tailor-made treatment including immunosuppressive therapy.


Assuntos
Bloqueio Atrioventricular/etiologia , Cardiomiopatia Hipertrófica/diagnóstico , Sarcoidose/complicações , Sarcoidose/diagnóstico , Assistência ao Convalescente , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Bloqueio Atrioventricular/diagnóstico , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Ablação por Cateter/métodos , Ecocardiografia/métodos , Fluordesoxiglucose F18/farmacocinética , Humanos , Imunossupressores/uso terapêutico , Masculino , Miocárdio/patologia , Tomografia por Emissão de Pósitrons/métodos , Prednisolona/uso terapêutico , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Resultado do Tratamento
8.
BMJ Case Rep ; 14(1)2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33414113

RESUMO

A 43-year-old man presented to hospital after routine laboratory tests showed an acute kidney injury and hypercalcaemia. He had no relevant medical history and normal physical examination, other than a 6-week history of lower back pain for which he had been taking naproxen. Low parathyroid hormone (PTH) levels indicated a PTH-independent hypercalcaemia. Investigations including CT of thorax, abdomen and pelvis and subsequent bone biopsy and renal biopsy were unremarkable. Positron emission tomography/CT (PET/CT) scan was ultimately considered as a diagnostic test and showed abnormalities in the right subpectoral and portacaval region with intense fluorodeoxyglucose F 18 uptake in local lymph nodes. A biopsy of the right subpectoral node showed granulomatous change consistent with sarcoidosis. PET/CT scanning can play an important role in the investigation of suspected malignancy, infection and inflammatory disease and in this case, was required to diagnose an atypical presentation of sarcoidosis.


Assuntos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Sarcoidose/diagnóstico , Lesão Renal Aguda/sangue , Adulto , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Humanos , Hipercalcemia/sangue , Linfonodos/patologia , Masculino , Hormônio Paratireóideo/sangue , Sarcoidose/diagnóstico por imagem
9.
Cancer Radiother ; 25(1): 51-54, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33376045

RESUMO

Bone location is uncommon in both sarcoidosis and in neck cancer (HNC). Diagnosis of a bone lesion is therefore challenging to distinguish its nature in a patient suffering from both diseases. We report the case of a 69-years-old woman referred for P16 positive HPV-HNC. Magnetic Resonance Imaging (MRI) showed T2 hypo-signal on iliac crest and spine. 18FDG-PET demonstrated radiotracer uptake on these locations suggesting bone metastasis. However, bone biopsy showed epithelioid granuloma without malignant cells compatible with sarcoidosis location. The diagnosis of both localized advanced HPV-HNC and systemic sarcoidosis (bone, central nervous system) were retained. The patient received corticosteroid regimen at 0.5mg/kg/day and Methotrexate for sarcoidosis and radiation and chemotherapy with platins for carcinoma. As granulomatous bone marrow infiltration may have an uptake on 18FDG-PET, bone sarcoidosis can mimic metastatic disease. In addition, MRI often fails to distinguish sarcoidosis lesions from metastatic lesion in bones. As no reliable imaging test can decipher both diseases, the description of our case reinforces the necessity to perform bone biopsy in a patient suffering from both conditions to expertise the nature of bone lesions.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Papillomavirus Humano 16 , Neoplasias Orofaríngeas/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Corticosteroides/uso terapêutico , Idoso , Doenças Ósseas/tratamento farmacológico , Quimiorradioterapia/métodos , Feminino , Humanos , Ílio/diagnóstico por imagem , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Metotrexato/uso terapêutico , Neoplasias Orofaríngeas/terapia , Neoplasias Orofaríngeas/virologia , Sarcoidose/tratamento farmacológico , Doenças da Coluna Vertebral/diagnóstico por imagem
10.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 306-312, nov.-dic. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-197925

RESUMO

Isolated neurosarcoidosis is a very rare disease, which makes up 5-15% of sarcoidosis cases. Hydrocephalus is a rare clinical feature with a prevalence of 6% among these patients. Considering neurosarcoidosis in the differential diagnosis of a unique parenquimal mass lesion could help in the early identification of this disease. We report the case of a 27-year-old African man who developed with a sole intracranial mass lesion mimicking radiologically a glioma, which finally came out as an isolated neurosarcoidosis. There is a difficulty in diagnosis when isolated neurosarcoidosis appears. In addition, the low prevalence of the disease entails a not standardized medical treatment. Natural outcome is poor even when hydrocephalus is resolved. Multimodal treatments including complete pharmacological treatment do not seem to assure a better outcome in these patients until date


La neurosarcoidosis cerebral aislada es una enfermedad muy rara, que representa entre el 5-15% de los casos de sarcoidosis. La hidrocefalia es una característica clínica poco frecuente, con una prevalencia del 6% entre estos pacientes. Considerar la neurosarcoidosis en el diagnóstico diferencial de una lesión de tipo masa parenquimatosa única puede ayudar en la identificación temprana de esta enfermedad. Presentamos el caso de un varón africano de 27 años de edad, que presenta una lesión de tipo masa única intracraneal que simulaba radiológicamente un glioma, y que finalmente se reveló como una neurosarcoidosis aislada. Es difícil establecer un diagnóstico cuando aparece una neurosarcoidosis cerebral aislada. Además, la baja prevalencia de la enfermedad conlleva un tratamiento médico no estandarizado. El pronóstico natural es malo, incluso cuando se resuelve la hidrocefalia. Hasta la fecha, los tratamientos multimodales, incluido el tratamiento farmacológico completo, no parecen asegurar un mejor resultado en estos pacientes


Assuntos
Humanos , Masculino , Adulto , Sarcoidose/diagnóstico por imagem , Sarcoidose/cirurgia , Hidrocefalia/cirurgia , Edema Encefálico/diagnóstico por imagem , Doenças do Sistema Nervoso Central/patologia , Hidrocefalia/diagnóstico por imagem , Diagnóstico Diferencial , Encefalopatias/diagnóstico por imagem , Biópsia , Corticosteroides/uso terapêutico , Edema Encefálico/patologia , Edema Encefálico/cirurgia
11.
Sci Rep ; 10(1): 21875, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33318556

RESUMO

Radiologic orbital imaging provides important information in the diagnosis and management of orbital inflammation. However, the diagnostic value of orbital imaging is not well elucidated. This study aimed to investigate the diagnostic accuracy of orbital imaging to diagnose orbital inflammatory diseases and its ability to detect active inflammation. We collected 75 scans of 52 patients (49 computed tomography (CT) scans; 26 magnetic resonance (MR) imaging scans). Clinical diagnoses included thyroid eye disease (TED) (41 scans, 31 patients), non-specific orbital inflammation (NSOI) (22 scans, 14 patients), sarcoidosis (4 scans, 3 patients), IgG4-related ophthalmic disease (IgG4-ROD) (5 scans, 3 patients), and granulomatosis with polyangiitis (GPA) (3 scans, 1 patient). Two experienced neuroradiologists interpreted the scans, offered a most likely diagnosis, and assessed the activity of inflammation, blinded to clinical findings. The accuracy rate of radiological diagnosis compared to each clinical diagnosis was evaluated. Sensitivity and specificity in detecting active inflammation were analyzed for TED and NSOI. The accuracy rate of radiologic diagnosis was 80.0% for IgG4-ROD, 77.3% for NSOI, and 73.2% for TED. Orbital imaging could not diagnose sarcoidosis. Orbital CT had a sensitivity of 50.0% and a specificity of 75.0% to predict active TED using clinical assessment as the gold standard. The sensitivity/specificity of orbital MR was 83.3/16.7% for the detection of active NSOI. In conclusion, orbital imaging is accurate for the diagnosis of IgG4, NSOI, and TED. Further studies with a large number of cases are needed to confirm this finding, especially with regard to uncommon diseases. Orbital CT showed moderate sensitivity and good specificity for identifying active TED.


Assuntos
Oftalmopatia de Graves/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Imagem por Ressonância Magnética , Órbita/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Inflamação/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
13.
Artigo em Inglês | MEDLINE | ID: mdl-33093765

RESUMO

Background: Patients with cardiac sarcoidosis (CS) are at increased risk of atrioventricular blocks, ventricular arrhythmias, and sudden cardiac death. Objectives We aimed to investigate the characteristics associated with appropriate therapy in implantable cardiac defibrillator (ICD) -implanted CS patients. Methods: We performed a PubMed and Web of Science search for studies reporting patients with CS who underwent an ICD implantation. The primary criterion was an appropriate therapy. Results: We screened 705 studies, of which 5 were included in the final analysis. We conducted a meta-analysis including 464 patients (mean age 55 years, 282 males (60%)). The mean follow-up was 3.5 years. Among the 464 patients, 180 received an appropriate therapy (39%). Patients who received an appropriate therapy were younger (-3.33, 95% confidence interval (CI) -6.42 to -0.23, p=0.004), were more likely to be male (OR 2.06, 95% CI 1.37-3.09, p=0.0005), had a lower left ventricular ejection fraction (LVEF) (-10.5, 95% CI -18.23 to -2.78, p=0.008), had a higher rate of complete heart block (OR 2.19, 95% CI 1.20 to 3.99, p=0.01), and more frequently had ventricular pacing (OR 6.44 95% CI 2.57 to 16.16, p<0.0001). Conclusions: Appropriate ICD therapy during CS is associated with young age, male sex, low LVEF, history of complete heart block, and ventricular pacing. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 17-23).


Assuntos
Cardiomiopatias/terapia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Bloqueio Cardíaco/terapia , Sarcoidose/terapia , Adulto , Fatores Etários , Idoso , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Morte Súbita Cardíaca/prevenção & controle , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/mortalidade , Bloqueio Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Sarcoidose/diagnóstico por imagem , Sarcoidose/mortalidade , Sarcoidose/fisiopatologia , Fatores Sexuais , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
15.
Am J Cardiol ; 134: 123-129, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32950203

RESUMO

Abnormalities on cardiac magnetic resonance imaging (CMR) and positron emission tomography (PET) predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). Little is known whether concurrent abnormalities on CMR and PET increases the risk of developing VA. Our aim was to compare the additive utility of CMR and PET in predicting VA in patients with CS. We included all patients treated at our institution from 2000 to 2018 who (1) had probable or definite CS and (2) had undergone both CMR and PET. The primary endpoint was VA at follow up, which was defined as sustained ventricular tachycardia, sudden cardiac death, or any appropriate device tachytherapy. Fifty patients were included, 88% of whom had a left ventricular ejection fraction >35%. During a mean follow-up 4.1 years, 7/50 (14%) patients had VA. The negative predictive value of LGE for VA was 100% and the negative predictive value of FDG for VA was 79%. Among groups, VA occurred in 4/21 (19%) subjects in the LGE+/FDG+ group, 3/14 (21%) in the LGE+/FDG- group, and 0/15 (0%) in the FDG+/LGE- group. There were no LGE-/FDG- patients. In conclusion, CMR may be the preferred initial clinical risk stratification tool in patients with CS. FDG uptake without LGE on initial imaging may not add additional prognostic information regarding VA risk.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Morte Súbita Cardíaca/epidemiologia , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico por imagem , Taquicardia Ventricular/epidemiologia , Fibrilação Ventricular/epidemiologia , Adulto , Idoso , Cardiomiopatias/complicações , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Medição de Risco , Sarcoidose/complicações , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
16.
Clin Nucl Med ; 45(11): 863-864, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32969900

RESUMO

A 68-year-old man with sarcoidosis showed high F-FDG uptake in the mediastinal and hilar lymph nodes on F-FDG PET, suggesting active inflammation. F-fluoro-boronophenylalanine (FBPA) PET showed no significant uptake in the mediastinal and hilar lymph nodes, suggesting its cancer specificity as a substrate of L-type amino acid transporter 1. F-fluoro-boronophenylalanine PET can be used for precise evaluation in oncology when the differentiation between inflammation and metastasis is inconclusive on F-FDG PET.


Assuntos
Fluordesoxiglucose F18/metabolismo , Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico por imagem , Sarcoidose/metabolismo , Idoso , Transporte Biológico , Humanos , Inflamação/metabolismo , Transportador 1 de Aminoácidos Neutros Grandes/metabolismo , Masculino , Sarcoidose/patologia , Sensibilidade e Especificidade
17.
Radiol Med ; 125(11): 1072-1086, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32970272

RESUMO

The restrictive cardiomyopathies constitute a heterogeneous group of myocardial diseases with a different pathogenesis and overlapping clinical presentations. Diagnosing them frequently poses a challenge. Echocardiography, electrocardiograms and laboratory tests may show non-specific changes. In this context, cardiac magnetic resonance (CMR) may play a crucial role in defining the diagnosis and guiding treatments, by offering a robust myocardial characterization based on the inherent magnetic properties of abnormal tissues, thus limiting the use of endomyocardial biopsy. In this review article, we explore the role of CMR in the assessment of a wide range of myocardial diseases causing restrictive patterns, from iron overload to cardiac amyloidosis, endomyocardial fibrosis or radiation-induced heart disease. Here, we emphasize the incremental value of novel relaxometric techniques such as T1 and T2 mapping, which may recognize different storage diseases based on the intrinsic magnetic properties of the accumulating metabolites, with or without the use of gadolinium-based contrast agents. We illustrate the importance of these CMR techniques and their great support when contrast media administration is contraindicated. Finally, we describe the useful role of cardiac computed tomography for diagnosis and management of restrictive cardiomyopathies when CMR is contraindicated.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiomiopatia Restritiva/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatia Restritiva/classificação , Fibrose Endomiocárdica/diagnóstico por imagem , Feminino , Humanos , Sobrecarga de Ferro/diagnóstico por imagem , Doenças por Armazenamento dos Lisossomos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/complicações , Lesões por Radiação/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem
18.
PLoS One ; 15(9): e0238391, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946452

RESUMO

BACKGROUND: Prognostic factors are lacking in cardiac sarcoidosis (CS), and the effects of immunosuppressive treatments are unclear. OBJECTIVES: To identify prognostic factors and to assess the effects of immunosuppressive drugs on relapse risk in patients presenting with CS. METHODS: From a cohort of 157 patients with CS with a median follow-up of 7 years, we analysed all cardiac and extra-cardiac data and treatments, and assessed relapse-free and overall survival. RESULTS: The 10-year survival rate was 90% (95% CI, 84-96). Baseline factors associated with mortality were the presence of high degree atrioventricular block (HR, 5.56, 95% CI 1.7-18.2, p = 0.005), left ventricular ejection fraction below 40% (HR, 4.88, 95% CI 1.26-18.9, p = 0.022), hypertension (HR, 4.79, 95% CI 1.06-21.7, p = 0.042), abnormal pulmonary function test (HR, 3.27, 95% CI 1.07-10.0, p = 0.038), areas of late gadolinium enhancement on cardiac magnetic resonance (HR, 2.26, 95% CI 0.25-20.4, p = 0.003), and older age (HR per 10 years 1.69, 95% CI 1.13-2.52, p = 0.01). The 10-year relapse-free survival rate for cardiac relapses was 53% (95% CI, 44-63). Baseline factors that were independently associated with cardiac relapse were kidney involvement (HR, 3.35, 95% CI 1.39-8.07, p = 0.007), wall motion abnormalities (HR, 2.30, 95% CI 1.22-4.32, p = 0.010), and left heart failure (HR 2.23, 95% CI 1.12-4.45, p = 0.023). After adjustment for cardiac involvement severity, treatment with intravenous cyclophosphamide was associated with a lower risk of cardiac relapse (HR 0.16, 95% CI 0.033-0.78, p = 0.024). CONCLUSIONS: Our study identifies putative factors affecting morbidity and mortality in cardiac sarcoidosis patients. Intravenous cyclophosphamide is associated with lower relapse rates.


Assuntos
Cardiomiopatias/tratamento farmacológico , Imunossupressores/uso terapêutico , Sarcoidose/tratamento farmacológico , Adulto , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/mortalidade , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Paris/epidemiologia , Prognóstico , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Sarcoidose/diagnóstico por imagem , Sarcoidose/mortalidade
19.
Brain Nerve ; 72(8): 871-882, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32741768

RESUMO

Sarcoidosis is a systemic granulomatous inflammation of unknown etiology that is reported in all age groups but with a higher prevalence in young adults. Sarcoidosis frequently involves the lungs, eyes, lymph nodes and skin. The involvement of the central nervous system (CNS) is reported with other sarcoidosis forms. Although only nervous system involvement presenting as CNS lesions are seen in 1% of cases, autopsy studies have confirmed CNS lesions in up to 25% of the cases. The nervous system including the brain, spinal cord, cerebral meninges, cranial nerves, pituitary gland, peripheral nerves, and muscles are reported to be affected. Although imaging findings of the nodules in sarcoidosis are nonspecific and atypical in 25-30% of cases, familiarity with the relevant clinical symptoms is helpful in recognizing sarcoidosis presence. The histopathological biopsy results of the organ affected by sarcoidosis help identify the characteristic noncaseating granuloma and its aggregation, and together with the imaging findings often reflecting such microstructure aid in sarcoidosis confirmation. This section describes the characteristic features seen in each image along with the image findings for each site.


Assuntos
Sarcoidose , Encéfalo , Diagnóstico Diferencial , Humanos , Neurologia , Sarcoidose/diagnóstico por imagem , Medula Espinal
20.
J Comput Assist Tomogr ; 44(5): 652-655, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842069

RESUMO

Immune checkpoint inhibitor therapy has revolutionized the treatment of many different types of cancer. However, despite dramatic improvements in tumor oncologic response and patient outcomes, immune checkpoint blockade has been associated with multiple distinctive side-effects termed immune-related adverse events. These often have important clinical implications because these can vary in severity, sometimes even resulting in death. Therefore, it is important for both radiologists and clinicians to recognize and be aware of these reactions to help appropriately guide patient management. This article specifically highlights imaging manifestations of the most common cardiothoracic toxicities of these agents, including pneumonitis, sarcoid-like granulomatosis and lymphadenopathy, and myocarditis.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Pneumonia , Sarcoidose , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/uso terapêutico , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico por imagem , Pneumonia/patologia , Sarcoidose/induzido quimicamente , Sarcoidose/diagnóstico por imagem , Sarcoidose/patologia , Tomografia Computadorizada por Raios X
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