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Final Program


Program-At-A-Glance

Quick Fire Session

Session: Quick Fire Session 4: Parametric Mapping and Cardiomyopathy (Monitor 15)

Typical cardiac involvement of Sarcoidosis by CMR

Friday, February 6, 2026
4:13 PM - 4:20 PM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)
Description of Clinical Presentation: Sarcoidosis is an inflammatory disease characterized by tissue granulomatosis, with no clearly defined etiological components. In cardiac sarcoidosis, symptoms are often nonspecific, requiring multimodal cardiology examinations. Imaging tests that detect areas of inflammation and fibrosis, such as cardiac magnetic resonance imaging (CMR), are highly useful for diagnosis and treatment.

A 35-year-old man from São Paulo, Brazil, diagnosed with systemic arterial hypertension in 2022, was regularly monitored by the cardiology team. In 2025, he remained asymptomatic and noted lower-than-normal heart rates during home heart rate and blood pressure measurements. After an outpatient consultation, an electrocardiogram revealed bradycardia and an increased PR interval. A 24-hour Holter monitor diagnosed various atrioventricular blocks (first-degree, second-degree Mobitz I and II). The echocardiogram showed no abnormalities, and the patient maintained preserved ventricular function. Due to conflicting results, a CMR was performed.

Diagnostic Techniques and Their Most Important Findings: In CMR, CINE (Steady State Free Precession) sequences showed cardiac chamber dimensions within normal limits, preserved biventricular systolic function, and a slight increase in myocardial thickness in the basal segment of the septal wall. The native myocardial T1 map was slightly increased. Sequences after paramagnetic contrast administration showed multifocal mesoepicardial late enhancement in the anteroseptal and inferoseptal walls (basal and middle) and in the apical inferior wall, in addition to linear mesocardial late enhancement in the basal inferolateral wall of the left ventricle and in the middle segment of the right ventricular free wall. In the basal anteroseptal segment of the left ventricle, there is extension into the right ventricle (hook sign). Further investigation with chest computed tomography revealed pulmonary nodular opacities and mediastinal lymph node enlargement, and fluorodeoxyglucose positron emission tomography (PET) revealed glycolytic hypermetabolism in these regions, as well as focal areas in the myocardium. The findings of multimodal imaging analysis corroborated the hypothesis of cardiac sarcoidosis. Finally the diagnosis of Sarcoidosis was confirmed by the lung Biopsy.

Learning Points from this Case: As in the reported case, to confirm the hypothesis of cardiac sarcoidosis most patients will require support from multiple diagnostic methods in cardiology and radiology, increasing the accuracy of clinical investigation by combining them.

Steady State Free Precession sequence (Short Axis)
Late Gadolinium Enhancement sequences (Short axis)
Hook Sign