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Diagnosing Isolated Cardiac Sarcoidosis.
MedLine Citation:
PMID:  21535250     Owner:  NLM     Status:  Publisher    
Objectives:  Cardiac sarcoidosis (CS) without clinically apparent extracardiac disease may escape detection due to the poor sensitivity of endomyocardial biopsy (EMB). We set out to analyse our experience of repeated and imaging-guided biopsies in clinically isolated CS. Methods:  We retrospectively reviewed the medical records, laboratory test results, imaging studies and pathological analyses of 74 patients with either histologically proven or clinically probable CS at our institution between January 2000 and December 2010. Results:  Fifty-two patients had histologically proven CS, of whom 33 (26 women) had disease that was clinically isolated to the heart. Sarcoidosis was detected in the first EMB in 10 of the 31 patients who underwent biopsy. CS was found by repeated EMBs, targeted by cardiac imaging, in seven additional patients, and 11 patients were diagnosed by sampling 18-F-fluorodeoxyglucose position emission tomography-positive mediastinal lymph nodes at mediastinoscopy. Together, the first biopsy (cardiac or mediastinal lymph node) provided the diagnosis in 34%, the second biopsy in 31% and the third in 22% of biopsied patients with isolated CS. Four (13%) of the remaining diagnosis were made after cardiac transplantation and one in a patient who did not undergo biopsy) at autopsy after sudden cardiac death. Conclusions:  CS may present without clinically apparent disease in other organs. At least two-thirds of patients remain undiagnosed after a single EMB session. The detection rate can be improved by repeated and imaging-guided cardiac or mediastinal lymph-node biopsies. Nevertheless, false-negative biopsy results remain a problem in CS patients with no apparent extracardiac disease.
Riina Kandolin; Jukka Lehtonen; Marit Graner; Jukka Schildt; Kaisa Salmenkivi; Sari M Kivistö; Markku Kupari
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-2
Journal Detail:
Title:  Journal of internal medicine     Volume:  -     ISSN:  1365-2796     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8904841     Medline TA:  J Intern Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Association for the Publication of the Journal of Internal Medicine.
Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, 00029 HUS, Finland Department of Clinical Physiology and Nuclear Medicine, HUSLAB, Helsinki University Central Hospital, 00029 HUS, Finland Department of Pathology, HUSLAB, Helsinki University Central Hospital, 00029 HUS, Finland Medical Imaging Center, Helsinki University Central Hospital, 00029 HUS, Finland.
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