Serial Imaging Changes During Treatment of Immunoglobulin G4–Related Disease With Multiple Pseudotumors

An 80-year-old man noticed a swollen eyelid on his left side and was admitted to our hospital. A chest x-ray showed eccentric cardiomegaly (Figure 1A), and transthoracic echocardiography revealed mild pericardial effusion and a large, low-echoic mass near the inferolateral left ventricular wall (Figure 1B). Other ultrasonic examinations showed thickened outer layers in the bilateral subclavian and iliac arteries (Figure 2B-1). A blood test indicated elevated levels of anti-immunoglobulin G (IgG; 4345 mg/dL), IgG4 (1210 mg/dL), C-reactive protein (7.08 mg/dL), and 60-minute erythrocyte sedimentation rate (100 mm/h). Figure 1. A , Chest x-ray showed eccentric cardiomegaly (arrow). B , Transthoracic echocardiography revealed mild pericardial effusion and a large, low-echoic mass near the inferolateral …