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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(04): 1002-1007
DOI: 10.1055/s-0041-1739379
Case Report

Cardiac Tuberculosis on 18F-FDG PET Imaging—A Great Masquerader of Cardiac Sarcoidosis

Sumati Sundaraiya
1   Department of Nuclear Medicine, Apollo Proton Cancer Centre, Tharamani, Tamil Nadu, India
,
Abubacker Sulaiman
2   Department of Radiology, Apollo Proton Cancer Centre, Tharamani, Tamil Nadu, India
,
Adhithyan Rajendran
2   Department of Radiology, Apollo Proton Cancer Centre, Tharamani, Tamil Nadu, India
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Abstract

A young gentleman with suspected cardiac sarcoidosis and LV dysfunction whose CMR revealed multifocal subepicardial to mid myocardial linear enhancement in the left ventricular myocardium underwent cardiac 18F-FDG PET imaging. The images revealed patchy regions of increased FDG uptake involving the apical to mid anterolateral, mid to basal anteroseptal/ right ventricular and mildly increased FDG uptake in apical inferior segments of the LV myocardium concordant with CMR findings. Whole body PET CT imaging showed multiple hypermetabolic supra and infra diaphragmatic lymphadenopathy, with no pulmonary lesion identified. Biopsy from the left para aortic lymph node revealed necrotizing granulomatous inflammation consistent with tuberculosis. Based on the histopathological findings of the lymph nodes, diagnosis of cardiac tuberculosis was made, given the similar imaging appearances in both sarcoidosis and TB. This case highlights that cardiac TB although rare, should be included in the differential diagnosis in patients with suspected infiltrative cardiomyopathy, particularly in TB endemic regions.

Keywords

cardiac tuberculosis - tuberculous myocarditis - cardiac 18F-FDG PET - myocardial hyper metabolism

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


Financial Support and Sponsorship

Nil.




Publication History

Article published online:
30 November 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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