Abstract

Cardiac sarcoidosis typically involves the myocardium. Pericardial effusion is uncommon, and symptomatic pericardial disease is even more infrequent. We report the case of a patient presenting with pericarditis as the first manifestation of sarcoidosis. A 50-year-old previously healthy man presented with chest pain and dyspnoea. The electrocardiogram confirmed the diagnosis of pericarditis. Computed tomography of the thorax showed pulmonary infiltrates with mediastinal and hilar adenopathies. Histological analysis of a lymph node biopsy was consistent with sarcoidosis. There was no evidence of myocardial involvement on Magnetic Resonance Imaging (MRI). We reviewed the available English literature and identified 31 cases with sarcoidosis and pericardial involvement. The majority of cases presented as pericardial effusion, which was often the first clinical manifestation of the disease. Pathological diagnosis usually occurs at extra-cardiac locations. Myocardial involvement, an important cause of morbidity and mortality, was found in 25.8% (8/31) of cases. Sarcoidosis should be considered in the differential diagnosis of patients presenting with pericardial disease. The optimal treatment regimen and long-term outcome remain largely unknown. Research in cardiac sarcoidosis should include pericardial disease as a separate manifestation in order to improve the management of this rare but likely underdiagnosed condition.

摘要

心肌结节病通常累及心肌。心包积液并不常见，有症状的心包疾病更为罕见。我们报告了一例以心包炎为结节病首发表现的患者。一名 50 岁的既往健康男性因胸痛和呼吸困难就诊。心电图证实了心包炎的诊断。胸部计算机断层扫描显示肺浸润伴纵隔和肺门腺病。淋巴结活检的组织学分析与结节病一致。磁共振成像 (MRI) 没有心肌受累的证据。我们回顾了现有的英文文献，确定了 31 例结节病和心包受累的病例。大多数病例表现为心包积液，这通常是该疾病的第一个临床表现。病理诊断通常发生在心外部位。心肌受累是发病率和死亡率的重要原因，在 25.8% (8/31) 的病例中被发现。在出现心包疾病的患者的鉴别诊断中应考虑结节病。最佳治疗方案和长期结果在很大程度上仍然未知。心脏结节病的研究应将心包疾病作为一种单独的表现，以改进对这种罕见但可能漏诊的疾病的管理。在出现心包疾病的患者的鉴别诊断中应考虑结节病。最佳治疗方案和长期结果在很大程度上仍然未知。心脏结节病的研究应将心包疾病作为一种单独的表现，以改善对这种罕见但可能漏诊的疾病的管理。在出现心包疾病的患者的鉴别诊断中应考虑结节病。最佳治疗方案和长期结果在很大程度上仍然未知。心脏结节病的研究应将心包疾病作为一种单独的表现，以改善对这种罕见但可能漏诊的疾病的管理。