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Cardiac imaging of a patient with unusual presentation of granulomatosis with polyangiitis: A case report and review of the literature

  • Case Presentation Corner
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Recent evidence suggests that cardiac involvement in patients with granulomatosis with polyangiitis (GPA) occurs more frequently than previously reported. Multimodality cardiac imaging is gaining attention in the diagnosis, prognostication, and follow-up of such patients; however, the data remain scarce.

Results

2D-TTE was useful for initial screening; while both cardiac magnetic resonance imaging and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) metabolic imaging with rubidium-82 PET perfusion imaging were useful for characterization of myocardial disease. 18FDG-PET/CT was very useful for the follow-up of cardiac disease activity following treatment.

Conclusion

18FDG-PET/CT is sensitive for the detection of cardiac involvement by GPA and is useful for the tissue characterization and follow-up of disease activity following treatment.

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Abbreviations

c-ANCA:

c-Anti-neutrophil cytoplasmic antibody

CMR:

Cardiac magnetic resonance

2D-TTE:

Two-dimensional transthoracic echocardiography

18FDG-PET/CT:

18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography

GPA:

Granulomatosis with polyangiitis

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

PET:

Positron emission tomography

STIR:

T2-weighted short-tau inversion recovery

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Acknowledgements

This work was funded by the Cardiovascular Disease in Women Research Chair at the Princess Nourah bint Abdulrahman University (Grant No. CDW-2019-02).

Disclosure

Rabah Al-Mehisen, Khalid Alnemri, and Maha Al-Mohaissen have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Cardiology, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia

    Rabah Al-Mehisen MBBS, SBIM, MRCPUK & Khalid Alnemri MBBS, FRCPC, FACC

  2. Department of Clinical Sciences (Cardiology), College of Medicine, Princess Nourah Bint Abdulrahman University, PO Box 48247, Riyadh, 11511, Kingdom of Saudi Arabia

    Maha Al-Mohaissen MBBS, SBIM, MRCPUK

  3. Princess Nourah Bint Abdulrahman University Cardiovascular Disease in Women Research Chair, Riyadh, Kingdom of Saudi Arabia

    Maha Al-Mohaissen MBBS, SBIM, MRCPUK

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  1. Rabah Al-Mehisen MBBS, SBIM, MRCPUK
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  2. Khalid Alnemri MBBS, FRCPC, FACC
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Correspondence to Maha Al-Mohaissen MBBS, SBIM, MRCPUK.

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Al-Mehisen, R., Alnemri, K. & Al-Mohaissen, M. Cardiac imaging of a patient with unusual presentation of granulomatosis with polyangiitis: A case report and review of the literature. J. Nucl. Cardiol. 28, 441–455 (2021). https://doi.org/10.1007/s12350-019-01809-6

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