Morphological Re-Evaluation of Cardiac Sarcoidosis ― A Case-Based Analysis of 14 Post-Mortem Japanese Hearts ―

Figures

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  Figure 1.. Representative epicardial anterior view of cardiac sarcoidosis. (A) Overall enlargement of the heart similar to dilated cardiomyopathy phenotype (case no. 12, 76-year-old woman). The epicardial surface was preserved, smooth, and homogeneous (bar=1 cm). (B) The epicardial surface has an irregular appearance, small dimples, and shrinkage (yellow arrows; case no. 3, 64-year-old man). (C) The heart was less dilated and the weight did not increase (270 g; case no. 10, 63-year-old man). The epicardial surface has a rough appearance.

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  Figure 2.. Representative fibrotic lesions in the transverse cross-section of both ventricles. (A) Simple isolated whitish fibrotic lesion at the epicardial side of the posterior right and left ventricular junction (yellow arrow; case no. 12, 76-year-old woman). The left ventricular cavity is slightly dilated without significant wall thinning (bar=1 cm). (B) White colored irregular fibrosis lesions in varying sizes are distributed in both ventricles, including the area of the posterior right and left ventricular junction (case no. 9, 45-year-old woman). The left ventricular cavity is dilated and less wall thinning is observed. (C) White fibrotic lesion located in the posterior right and left ventricular junction. Left ventricular wall thickening is observed without thinning of the posterolateral wall (yellow arrow; case no. 2, 63-year-old man).

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  Figure 3.. Representative longitudinal section of the right and left atriums and ventricles (4-chamber view). (A) The summit of the ventricular septum is regionally thinned with fibrosis. The thinned wall curves to the right ventricle, which is affected by blood flow pressure (yellow arrow; case no. 8, 86-year-old woman; posterior-anterior side view). The anterior wall of the atrioventricular junction beneath the mitral valve is consecutively thinned, extending from the thinned septal lesion. (B) The ventricular septal wall is completely thinned from the atrioventricular junction to the apex edge (case no. 3, 64-year-old man; anterior-posterior side view). Thinned lesions extend to both ventricles. Black colored lesions indicate radiofrequency ablation sites for eliminating ventricular tachycardia. (C) The thickness of the ventricular septal wall is well preserved (case no. 2, 63-year-old man). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

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  Figure 4.. Representative images of localized left ventricular free wall aneurysm. (A) The left ventricular wall is thinned regionally (27 mm in longitudinal length). The fibrotic lesion is prominent in the epicardial side and shows an irregular aspect (yellow arrow). The endocardial trabecula is relatively preserved and shows a complicated endocardial surface in the aneurysm (case no. 3, 64-year-old man; posterior-anterior side view). (B) The left ventricular wall is focally thinned without aneurysmal bulge towards the epicardial side (yellow arrow; 22 mm in length; case no. 2, 63-year-old man). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

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  Figure 5.. Representative lesions of the papillary muscle. (A) Fibrotic atrophy of the papillary muscle. The base of the papillary muscle shows continuous fibrosis and shows an irregular epicardial aspect (yellow arrows; case no. 7, 67-year-old man). (B) The papillary muscle is deformed and shortened (case no. 3, 64-year-old man). The tendinous cords are stretched by the lesion. Black colored lesions indicate radiofrequency ablation sites for eliminating ventricular tachycardia. LA, left atrium; LV, left ventricle.