FIT Clinical Decision-Making Cases
Submission Dates: Tuesday, Aug. 28 – Thursday, Oct. 18
The submission deadline for FIT Clinical Decision-Making Cases was October 18, 2018.
FIT Clinical Decision-Making Cases will be peer-reviewed and selected for presentation in one of two formats — during a special “Stump the Professor” session at ACC.19, which all FITs are invited to attend, or as a traditional or moderated poster.
FITs should submit an interesting case with teaching points written in abstract style. The selection criteria is based upon the clinical decision-making used to arrive at a diagnosis and/or treatment. Selection is not based on just a great image or technically challenging procedure. The case scenario must illustrate clinical decision-making with teaching points and include the following sections: Background, Case Description, Decision-Making and Conclusion. For more information refer to the sample case below, which was submitted and presented at a previous meeting.
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Sample Clinical Decision-Making Case
|Sample Case 1|
|Publishing Title:||The Great Masquerader: Cardiac Sarcoidosis Mimicking Arrhythmogenic Right Ventricular Dysplasia|
Background: Infiltrative cardiomyopathies have overlapping features by conventional imaging criteria; Precise diagnosis requires a multimodality approach and has important implications for treatment.
Case: A 49 year old male presented in ventricular tachycardia which terminated with lidocaine. Baseline EKG was significant for an epsilon wave in V1 (Figure1G). Echocardiography revealed global hypokinesis and catheterization showed non-obstructive coronary disease. Cardiac MRI revealed a right ventricular EF of 26% with a focal aneurysm of the free wall (Figure 1A) and late gadolinium enhancement throughout both ventricles (Figure 1B-C) but no hilar adenopathy (Figure 1D).
Decision‐making: This patient met two 2010 ARVD Task Force major criteria. Cardiac biopsy showed fibrosis without fatty infiltration or granulomas. Genetic testing was negative for known ARVD mutations. Investigation for sarcoidosis was prompted; a PET scan 6 months later noted hypermetabolic hilar adenopathy (Figure 1E-F). A lymph node biopsy showed fibrosis and non-necrotic granulomas (Figure1H) consistent with multiple proposed criteria for the diagnosis of cardiac sarcoidosis. In addition to standard cardiomyopathy therapy, the patient was treated with oral steroids with no further arrhythmias.
Conclusion: This case highlights cardiac sarcoidosis as a masquerader sharing features of ARVD and underlines the importance of a multimodality imaging approach as well as biopsies for proper diagnosis and treatment.
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