Background: Cardiac involvement in sarcoidosis is associated with a poor prognosis. In patients with right sided heart failure, differentiating between cor-pulmonale, or cardiac sarcoidosis has important implications to management.
Case presentation: We present the case of a patient with severe but stable pulmonary sarcoidosis and new onset right sided heart failure despite only mild elevations of pulmonary artery pressure. CMR demonstration of extensive right ventricular fibrosis with associated dilatation and hypokinesis was a key finding for prognosis and management of the patient.
Conclusion: Cardiac magnetic resonance (CMR) is the preferred investigation in the diagnosis of cardiac sarcoidosis, allowing assessment of myocardial inflammation and fibrosis, as well as function, in a manner not matched by other technologies.