Clinics in diagnostic imaging (189). Acute phase cardiac sarcoidosis (CS).

A 44-year-old man presented with breathlessness and episodes of palpitations for the last one year. The imaging diagnosis of cardiac sarcoidosis was made based on chest radiography and cardiac magnetic resonance (MR) imaging findings, and was further confirmed by biopsy. Cardiac sarcoidosis is an uncommon entity, yet is potentially fatal with nonspecific clinical manifestations, including sudden cardiac death. Hence, it is important to diagnose and treat this entity at an early stage to improve morbidity and mortality. Cardiac MR imaging plays a pivotal role in facilitating diagnosis and monitoring therapeutic response. We describe the MR imaging features of cardiac sarcoidosis and discuss imaging features of other cardiomyopathies that may mimic cardiac sarcoidosis.

Primary hepatic amyloidosis presenting as nodular masses on the background of diffuse infiltration and extreme liver stiffness on MR elastography.

Amyloidosis is characterized by the deposition of extracellular protein material, amyloid, in various organs. The clinical and imaging features of the disease are often nonspecific and a tissue biopsy is often required. We present the case of a 64-year-old man with biopsy proven amyloidosis of the liver. The patient presented with non-specific clinical symptoms. Routine imaging showed hepatomegaly with heterogeneous enhancement, and several large nodular space occupying lesions, mimicking neoplasm. MR elastography revealed an extremely stiff liver. Amyloidosis presenting as multiple nodular masses on the background of diffuse infiltrative pattern or demonstration of extreme stiffness in hepatic amyloidosis on MR elastography have not been described previously.

Clinics in diagnostic imaging (152). Right lower lobe segmental pulmonary embolus.

A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton's hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dual-energy computed tomography innovations.