Observation of Developing Left Ventricular Aneurysm in Cardiac Sarcoidosis

A 56-year-old woman developed dizziness. She visited to her regular physician. C-reactive protein level increased and hyperglycemia was revealed. She was a referral to general hospital and diagnosed as type 1 diabetes mellitus. Two days later from hospitalization, computed tomography demonstrated pericardial effusion. Electro-cardiogram showed complete atrial ventricular block and troponin T was positive. She was a referral to our hospital because acute myocardial infarction or acute myocarditis were suspected. Transthoracic echocardiography revealed left ventricular dysfunction. Severe hypokinesis in inferior wall. Emergent coronary angiography showed intact. Troponin I and Brain natriuretic peptide were 4617 pg/mL and 528.6 pg/mL, respectively. We diagnosed as acute myocarditis and acute heart failure. She was hospitalization and received medical therapy. Cardiac Magnetic Resonance Imaging showed delayed enhancement in inferior wall. Paired serum did not show significant increasing. After treatment, acute heart failure was compensated and she discharged on day 13 from hospitalization. After that, transthoracic echocardiography showed that inferior wall got thinning and developed aneurysm gradually. We suspected cardiac sarcoidosis. There is not significant findings with endomyocardial biopsy. Fluorodeoxyglucose positron emission tomography revealed uptake in inferior and lateral wall. We diagnosed as cardiac sarcoidosis and she has received steroid therapy. We report this case because using transthoracic echocardiography, observation of developing left ventricular aneurysm in cardiac sarcoidosis is rare.