The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / 2014 ACR/ARHP Annual Meeting: Diagnosis, Management of Sarcoidosis in the Heart, Central Nervous System

2014 ACR/ARHP Annual Meeting: Diagnosis, Management of Sarcoidosis in the Heart, Central Nervous System

March 1, 2015 • By Kathy Holliman

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Guidelines
A previously healthy 32-year-old man presented with a severe cardiomyopathy. On a gated Rubidium-82 perfusion and cardiac PET study, there was epicardial and myocardial hyperenhancement with sparing of the subendocardium (panel A, below). Fluorodeoxyglucose avidity was evident in enlarged hilar and right paratracheal lymph nodes (panel B, below). On an apical core myocardial biopsy, noncaseating, well-formed granulomas composed of epithelioid histiocytes and multinucleated giant cells infiltrated the myocardium. A collagenous stroma around the granulomas represented areas of previous myocardial injury (panel C, above: hematoxylin and eosin stain, 100X magnification).

BOSTON—Diagnosis of both cardiac sarcoidosis and neurosarcoidosis requires a process of exclusion and a high degree of clinical suspicion, according to a presentation at the ACR/ARHP Annual Meeting in Boston in November 2014, Sarcoidosis in 2014. Akin to problems associated with the general diagnosis of sarcoidosis, there is no one reliable diagnostic test for either condition, the clinical manifestations can be nonspecific, and there are no evidence-based guidelines for treatment.

You Might Also Like
  • 2015 ACR/ARHP Annual Meeting: Unknowns Persist Around Sarcoidosis Etiology, Pathogenesis, Treatment
  • 2014 ACR/ARHP Annual Meeting: Rheumatoid Arthritis Management Treatment Recommendations
  • 2014 ACR/ARHP Annual Meeting: Diagnosing PACNS and Its Mimics
Explore This Issue
March 2015
Also By This Author
  • Updated Guidelines and New Therapies for Osteoporosis Coming this Year

Daniel Culver, DO, a pulmonologist at the Cleveland Clinic, said diagnosis of cardiac sarcoidosis can be difficult and should include a finding of sarcoidosis in an organ outside the heart and presence of a heart lesion that cannot be explained by other causes. A patient’s symptoms, however, are still the most important for diagnosis.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

“I ask my patients: ‘Are you having palpitations, are you having dizzy spells, have you passed out?’ If any of those things are true, you have to go looking hard for a diagnosis of cardiac sarcoidosis,” he said.

Patients with cardiac sarcoidosis can have congestive heart failure, impaired systolic function, ventricular dysfunction, conduction delays and reduced left ventricular ejection fraction. The symptoms can range from asymptomatic conduction abnormalities to fatal ventricular arrhythmias, depending on the location and extent of granulomatous inflammation.1

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Screening for cardiac sarcoidosis should include not only an assessment of the patient’s symptoms, but also an electrocardiogram that can help detect any conduction system abnormalities and whether the heart is involved. Blood test abnormalities are not useful for diagnosis.

Imaging Modalities Used in Diagnosis

No gold standard has been established for imaging cardiac sarcoidosis, and the sensitivity and specificity of imaging modalities are limited. However, contrast-enhanced magnetic resonance imaging (MRI) “does have some utility,” Dr. Culver said. “When you see late enhancement on MRI, that’s a sign that the patient is likely to have some issue. Patients with late enhancement have a worse course.”

Pages: 1 2 3 | Single Page

Filed Under: Conditions, Meeting Reports, Systemic Inflammatory Syndromes Tagged With: ACR/ARHP Annual Meeting, central nervous system, Diagnosis, heart, Holliman, rheumatology, SarcoidosisIssue: March 2015

You Might Also Like:
  • 2015 ACR/ARHP Annual Meeting: Unknowns Persist Around Sarcoidosis Etiology, Pathogenesis, Treatment
  • 2014 ACR/ARHP Annual Meeting: Rheumatoid Arthritis Management Treatment Recommendations
  • 2014 ACR/ARHP Annual Meeting: Diagnosing PACNS and Its Mimics
  • 2014 ACR/ARHP Annual Meeting: Sjögren’s Complications

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)