A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 60-year-old woman with a past medical history of sarcoidosis presents with increasing shortness of breath and fatigue over the last 4 weeks. She denies cough or fever. Her temperature is 36.7°C (98.1°F), pulse is 86/min, respirations are 18/min, and blood pressure is 122/80 mmHg. Physical examination reveals bilateral rales at the lung bases and an S3 heart sound. Laboratory studies show normal renal function and no proteinuria. An echocardiogram demonstrates preserved ejection fraction, biatrial enlargement, and diastolic dysfunction. Which of the following is most likely to be seen on cardiac MRI?
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A
Apical aneurysm formationIncorrect. Apical aneurysms suggest end-stage hypertrophic cardiomyopathy or prior MI, not infiltrative sarcoid involvement causing restrictive physiology.
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B
Pericardial effusionIncorrect. Pericardial effusion may occur in sarcoidosis but doesn't explain biatrial enlargement and diastolic dysfunction from myocardial infiltration.
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C
Right ventricular hypertrophyIncorrect. Right ventricular hypertrophy indicates pulmonary hypertension or pressure overload, not myocardial sarcoid infiltration with preserved EF.
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D
Diffuse subendocardial enhancementIncorrect. Diffuse subendocardial late gadolinium enhancement is classic for cardiac amyloidosis, not the patchy mid-wall pattern of sarcoidosis.
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E
Myocardial scarring and fibrosisCorrect. Cardiac sarcoidosis produces patchy myocardial scarring and fibrosis on MRI, causing the restrictive physiology and biatrial enlargement shown.
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Answer: E. The patient's sarcoidosis and echocardiographic findings suggest infiltrative cardiomyopathy, specifically restrictive cardiomyopathy due to sarcoid infiltration. Cardiac MRI would likely show myocardial scarring and fibrosis, a hallmark of cardiac involvement in sarcoidosis. Diffuse subendocardial enhancement is more suggestive of amyloidosis, and apical aneurysm formation is not typical of RCM. Pericardial effusion and right ventricular hypertrophy are not characteristic findings in this context.