Significant Pericardial Involvement of Immunoglobulin G4–Related Disease Takehiro Morita, MD, Atsushi Izawa, MD, Hideaki Hamano, MD, Naoko Asano, MD,

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Significant Pericardial Involvement of Immunoglobulin G4–Related Disease Takehiro Morita, MD, Atsushi Izawa, MD, Hideaki Hamano, MD, Naoko Asano, MD, Ayako Kozuka, MD, Hideaki Moteki, MD, Megumi Fuke, MD, Jun Koyama, MD, Jun Amano, MD, Uichi Ikeda, MD The Annals of Thoracic Surgery Volume 98, Issue 2, Pages e47-e49 (August 2014) DOI: 10.1016/j.athoracsur.2014.04.069 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Computed tomography scan image showing diffuse thickening of the pericardium (arrows). (B) Anterior (left) and posterior (right) images of 67-gallium scintigram showing an enhanced uptake around the heart. The Annals of Thoracic Surgery 2014 98, e47-e49DOI: (10.1016/j.athoracsur.2014.04.069) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Tissue sections of the pericardium showing (A) massive infiltration of mononuclear cells and plasma cells (H&E, ×100) (inset, H&E, ×200), and (B) IgG4-positive plasma cells (IgG4, ×100) (inset, ×200). (Bars = 50 μm; H&E = hematoxylin and eosin; IgG4 = immunoglobulin G4.) The Annals of Thoracic Surgery 2014 98, e47-e49DOI: (10.1016/j.athoracsur.2014.04.069) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Tissue sections of the mediastinal lymph node showing (A) follicular hyperplasia (H&E, ×20), (B) marked infiltration of plasma cells (H&E, ×100) (inset, H&E, ×200), and (C) IgG4-positive plasma cells. (IgG4, ×100) (inset, ×200) (Bars = 50 μm; H&E = hematoxylin and eosin; IgG4 = immunoglobulin G4.) The Annals of Thoracic Surgery 2014 98, e47-e49DOI: (10.1016/j.athoracsur.2014.04.069) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Computed tomography scan images showing bilateral enlargement of the submandibular glands (arrows), which subsequently demonstrated (B) significant reduction in size after 8 weeks of corticosteroid treatment. (C) Reduction in the pericardial thickening (arrows) was also observed. The Annals of Thoracic Surgery 2014 98, e47-e49DOI: (10.1016/j.athoracsur.2014.04.069) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions