Open chest core needle biopsy of left ventricle in the evaluation of suspected focal myocardial inflammation Jukka Y.A. Lehtonen, MD, Janne J. Jokinen,

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Presentation transcript:

Open chest core needle biopsy of left ventricle in the evaluation of suspected focal myocardial inflammation Jukka Y.A. Lehtonen, MD, Janne J. Jokinen, MD, Miia Holmström, MD, Markku Kupari, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 6, Pages e99-e102 (June 2015) DOI: 10.1016/j.jtcvs.2015.03.016 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Visible and palpable abnormal area in the lateral aspect of the left ventricle (white arrow). Diagnostic biopsy specimen was taken by punching a 14G core needle through the lesion. Microscopy revealed granulomatous myocarditis consistent with CS (case 1). The Journal of Thoracic and Cardiovascular Surgery 2015 149, e99-e102DOI: (10.1016/j.jtcvs.2015.03.016) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 cMRI, 18FDG-PET, and histology in case 1. A, Horizontal long-axis view of cMRI. Note myocardial late enhancement (arrow). B, 18FDG-PET shows a wide focus of active glucose uptake. C, Histology showing giant cells (arrow) and other findings diagnostic of GCM (40×, hematoxylin–eosin). The Journal of Thoracic and Cardiovascular Surgery 2015 149, e99-e102DOI: (10.1016/j.jtcvs.2015.03.016) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 cMRI, 18FDG-PET, and histology in case 2. A, Horizontal long-axis view of cMRI showing a strongly late-enhancing local myocardial expansion (arrow). B, 18FDG-PET image with focal hot spot (arrow). C, Microscopic findings, including granulomas (arrow), consistent with CS (40×, hematoxylin–eosin). The Journal of Thoracic and Cardiovascular Surgery 2015 149, e99-e102DOI: (10.1016/j.jtcvs.2015.03.016) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 cMRI, 18FDG-PET, and histology in case 3. A, Horizontal long-axis view of gadolinium-MRI demonstrating a sharply demarcated late-enhancing expansion (arrow) in the lateral LV wall. B, 18FDG-PET image with hot spot in the LV lateral wall. C, Microscopic findings diagnostic of CS (40×, hematoxylin–eosin). The Journal of Thoracic and Cardiovascular Surgery 2015 149, e99-e102DOI: (10.1016/j.jtcvs.2015.03.016) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions