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(Circulation. 2009;120:82-85.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Loeffler Endocarditis Mimicking Apical Hypertrophic Cardiomyopathy

Sung-A Chang, MD; Hyung-Kwan Kim, MD; Eun-Ah Park, MD; Yong-Jin Kim, MD; Dae-Won Sohn, MD

From the Departments of Internal Medicine (S.A.C., H.-K.K., Y.-J.K., D.-W.S.) and Radiology (E.-A.P.), Seoul National University Hospital, Seoul, Korea.

Correspondence to Yong-Jin Kim, MD, PhD, Associate Professor, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. E-mail kimdamas@snu.ac.kr

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 35-year-old woman presenting with left-side weakness visited our emergency room. She was previously healthy and did not have any clinical risk factors for cerebral vascular disease. Multiple embolic cerebral infarctions were found in her brain through magnetic resonance imaging (MRI). An ECG showed ST depression and T-wave inversion in all of the precordial leads (Figure 1). An abnormal eosinophil count (2718 per 1 µL) and elevated erythrocyte sedimentation rate (58 mm/h) were reported in her blood test; otherwise, her blood test was normal. Her cardiac enzyme level was within normal limits. Transthoracic echocardiography was performed (Figure 2 and online-only Data Supplement Movies I and II), and apical hypertrophy suggesting apical cardiomyopathy was initially reported.

View larger version (114K):   Figure 1. Initial ECG at the emergency room. T-wave inversions were present in all the precordial leads.

View larger version (46K):   Figure 2. Apical 4-chamber view (A) and apical short-axis view (B) in the initial echocardiography showing abnormal thickening of the left ventricular apex.

Further workup for the eosinophilia, including parasitic disease, did not give any additional information. She was admitted to the neurology department and treated with anticoagulation. She complained of recurrent chest discomfort after admission, and cardiac computed tomography was performed for workup. Coronary arteries were normal, but a low attenuated endomyocardial lesion in the left ventricular apex was reported (Figure 3). Cardiac MRI depicted apical thrombus (nonenhancing lesion) with endocardial enhancement after administration of gadopentetate dimeglumine, suggesting Loeffler endocarditis^1,2 (Figure 4). Reevaluation of the apex by transthoracic echocardiography after . . . [Full Text of this Article]