Related Experiment Videos
Cardiac sarcoidosis
1Department of Pathology, Osaka City University Medical School, Japan.
Insights
This case highlights cardiac sarcoidosis presenting as heart failure. Extensive lung examination revealed granulomas, confirming sarcoidosis diagnosis and emphasizing careful microscopic evaluation for cardiac sarcoidosis.
Area of Science:
- Cardiology
- Pulmonology
- Pathology
Background:
- Cardiac sarcoidosis is a rare condition.
- It can present with various cardiac conduction abnormalities and heart failure.
- Systemic signs of sarcoidosis may be absent.
Purpose of the Study:
- To report a case of cardiac sarcoidosis.
- To emphasize the diagnostic challenges in cases without systemic evidence.
- To highlight the importance of thorough histopathological examination.
Main Methods:
- Case report of a patient with unexplained heart failure.
- Postmortem examination of cardiac and pulmonary tissues.
- Histopathological analysis including serial sectioning of lung tissue.
Main Results:
- The patient developed complete right bundle branch block, atrioventricular block, and congestive heart failure.
- Postmortem revealed extensive noncaseating granulomas in the myocardium.
- Inconspicuous granulomatous lesions were identified in the lungs only after extensive serial sectioning.
Conclusions:
- Cardiac sarcoidosis can occur without overt systemic manifestations.
- Extensive and meticulous histopathological examination, including serial sections, is crucial for diagnosing cardiac sarcoidosis.
- This case underscores the diagnostic utility of thorough microscopic examination of affected organs.
Abstract:
The present report describes a patient with cardiac sarcoidosis who developed complete right bundle branch block, complete atrioventricular block and subsequent congestive heart failure. The patient demonstrated no clinical evidence of systemic sarcoidosis. Upon postmortem examination, the myocardium showed extensive noncaseating granuloma with numerous multinucleated giant cells. An initial routine microscopic examination of the lung revealed no evidence of granulomatous lesions. However, an extensive microscopic examination of the lung using serial sections demonstrated inconspicuous granulomatous lesions with giant cells. Thereby, a diagnosis of sarcoidosis was made. All other organs were free of granulomatous inflammation in spite of an extensive microscopic examination through serial sections. The present case suggests that a careful and extensive microscopic examination of the other organs may be necessary to establish a diagnosis of cardiac sarcoidosis.