A 72-year-old male with a neck tumor was referred because of pericardial effusion (PE) on whole-body non-contrast computed tomography (CT) screening. ECG-gated CT was performed, and thickening of the pericardium (Figure A,B; blue areas indicated by arrows in Figure C) and left coronary artery (LAD) wall (Figure D, white arrows) were detected. The thickened pericardium showed late enhancement (Figure A,B, white arrows).
His immunoglobulin 4 (IgG4) level was 2,270 mg/dL (normal range, 11–121 mg/dL), and immunohistochemical testing revealed numerous IgG4-positive plasma cells in the submandibular gland (Figure E).
Together, the results confirmed IgG4-related pericarditis, periaortitis, and coronary arteritis (CA). After almost 1 year of steroid therapy, the thickened LAD wall and pericardium with PE disappeared (Figure F–H), and the IgG4 level had decreased to 280 mg/dL.
Cardiovascular complications should not be overlooked in IgG4-related disease.1 From our review of the literature, this is the first case report demonstrating the usefulness of CT for follow-up of the coincidence of IgG4-related pericarditis, CA, and periaortitis.
Disclosure
Y.K. is a member of the Circulation Reports’ Editorial Team.
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Informed consent was obtained.
