Antemortem diagnosis of cardiac sarcoidosis by abnormal uptake of 201Tl in bilateral hilar lymph nodes.

The antemortem diagnosis of cardiac sarcoidosis is extremely difficult. We present a patient with congestive heart failure and cardiomyopathy of unknown cause who exhibited an abnormal accumulation of 201Tl in both hilar lymph nodes in addition to a perfusion defect of the left ventricular myocardium. The findings ultimately led to a diagnosis of myocardial sarcoidosis, which was treated successfully with prednisolone. Although such uptake in the hilar nodes has rarely been reported previously, and the mechanism is not known, this was a remarkable finding in diagnosing cardiac sarcoidosis in this case. When the abnormal hilar lymph nodes uptake of 201Tl is combined with the defect in the left ventricular myocardium, we should take cardiac sarcoidosis into consideration as the cause of secondary cardiomyopathy.