Cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis: presenting as ventricular tachycardia.

A 41-year-old man was admitted following an episode of sustained ventricular tachycardia with hemodynamic compromise (Fig. 1). He had a history of hypertension, treated with enalapril, with no other noteworthy personal or family medical history. He underwent successful cardioversion to sinus rhythm with a single synchronized, 100-J biphasic, direct-current shock. Serial electrocardiograms and cardiac enzyme measurements were noncontributory. Transthoracic echocardiography revealed normal overall left and right ventricular function. Coronary angiography showed minor coronary artery disease. Cardiovascular magnetic resonance (CMR) with gadolinium-DTPA revealed a mildly dilated left ventricle with basal septal and inferoseptal akinesis and mild systolic dysfunction (ejection fraction, 0.40); extensive late gadolinium enhancement involving the basal septal, inferior, and lateral segments of the left ventricle (Figs. 2 and ​and3);3); and hilar lymphadenopathy with patchy right-upper-lobe lung infiltrates (Fig. 4). A hilar lymph node biopsy confirmed the diagnosis of sarcoidosis. An implantable cardioverter-defibrillator was inserted and thoracic follow-up was arranged. Fig. 1 Rhythm tracing demonstrates sustained ventricular tachycardia. Fig. 2 Basal short-axis post-gadolinium inversion recovery gradient-echo image shows extensive late gadolinium enhancement in the basal septal, inferior, and lateral segments of the left ventricle (arrowheads). Fig. 3 Vertical long-axis image after gadolinium administration shows patchy, mid-wall late gadolinium enhancement in the basal to mid-inferior segments of the left ventricle (arrowheads). Fig. 4 Axial dark-blood image of the lung fields and mediastinum, with use of a half-Fourier acquisition turbo spin-echo technique, shows prominent hilar lymphadenopathy (asterisk) and parenchymal lung infiltrates (arrow).