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(Circulation. 2001;104:e3.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Hypereosinophilic Syndrome and Restrictive Cardiomyopathy Due to Apical Thrombi

Gregory G. Bishop, MD; James D. Bergin, MD; Christopher M. Kramer, MD

From the Departments of Medicine and Radiology, University of Virginia, Charlottesville, Va.

Correspondence to Christopher M. Kramer, MD, University of Virginia Health System, Departments of Medicine and Radiology, Box 800170, Charlottesville, VA 22908. E-mail ckramer{at}virginia.edu

A 57-year-old woman had a history of idiopathic hypereosinophilic syndrome (previously treated with hydroxyurea) and recent progression to myelodysplastic syndrome. She presented with 6 months of fatigue, 2 months of progressive dyspnea on exertion and orthopnea, a 10-pound weight gain, and increased abdominal girth. On admission, she appeared chronically ill and had tachycardia, jugular venous distention to the angle of the jaw, bilateral basilar rales, an S3 gallop, and trace peripheral edema. An ECG revealed sinus tachycardia, septal Q waves, and inferolateral STT wave changes. A transthoracic echocardiogram revealed masses in the apices of the left and right ventricular cavities but normal biventricular size and function. During her initial hospital course, she was treated for eosinophilic endomyocardial disease with steroids, diuresis, and anticoagulation without resolution of symptoms. Surgical resection of the masses was considered, but because it was unclear whether a plane existed between the apical masses and the myocardium, we performed an MRI of the heart (Figures 1 to 4). A distinct plane was demonstrated; therefore, surgery was performed with removal of the left and right ventricular apical masses. Significant diuresis occurred, followed by clinical improvement. Pathological examination of the masses demonstrated thrombus.

View larger version (149K): [in this window] [in a new window]   Figure 1. Four-chamber, long-axis, breath-hold, T1-weighted gradient echo cine image showing masses in apex of right and left ventricles.

View larger version (147K): [in this window] [in a new window]   Figure 2. Two-chamber, long-axis, T1-weighted gradient echo cine image in parasagittal plane showing left ventricular apical mass with distinct signal properties from the myocardium.

View larger version (143K): [in this window] [in a new window]   Figure 3. T1-weighted gradient echo-tagged end-systolic cine image in the 4-chamber long-axis plane demonstrating intramyocardial dysfunction in the left ventricular apex (lack of tag stripe deformation) but preserved function in the basal septum and lateral wall.

View larger version (128K): [in this window] [in a new window]   Figure 4. First-pass, inversion-recovery gadolinium-diethylene triaminepentacetic acid (Gd-DPTA)-enhanced image in 4-chamber, long-axis plane. Intact perfusion of the myocardium, no perfusion of the mass, and a distinct plane between the mass and myocardium were identified.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St.Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editoral Office, St.Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.

This article has been cited by other articles:

				G. C. Salanitri Endomyocardial Fibrosis and Intracardiac Thrombus Occurring in Idiopathic Hypereosinophilic Syndrome Am. J. Roentgenol., May 1, 2005; 184(5): 1432 - 1433. [Full Text] [PDF]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bishop, G. G. Articles by Kramer, C. M. Search for Related Content PubMed PubMed Citation Articles by Bishop, G. G. Articles by Kramer, C. M. Related Collections Other heart failure Congestive Cardiovascular imaging agents/Techniques Myocardial cardiomyopathy disease CT and MRI