Hypereosinophilic Syndrome: A rare case of Loeffler's endocarditis documented in cardiac MRI
ABSTRACT Cardiac manifestation of Hypereosinophilic Syndrome usually presents as Loeffler's endocarditis; this case of unusual manifestation of Hypereosinophilic Syndrome, however, revealed restrictive left ventricular dysfunction and increased left ventricular wall mass. Both, an endocardiac eosinophilic mass and layers of intraventricular thrombus were demonstrated and followed by echocardiography and MRI under treatment. The current case demonstrates not only the diagnostic potential of magnetic resonance imaging (MRI) to visualize eosinophilic infiltrate and thrombus, but also morphologic changes with treatment by oral anticoagulation and immunosuppression. With 6 months of intense medical treatment cardiac MRI was instrumental to document both the endocardiac mass and improvement of left ventricular function.
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ABSTRACT: Cardiac manifestations of the hypereosinophilic syndrome (HES), first described by Loeffler in 1936, are rare and difficult to image. We report a fatal case of Loeffler's endocarditis in a 71 year-old female with a history of asthma. An initial transthoracic echocardiogram demonstrated normal wall motion and a suggestion of left ventricular apical thrombus. However, using cardiac MRI with ultra fast inversion-recovery (IR) delayed enhancement, gradient recalled echo (GRE) grid-tagging and cine steady-state free precession (SSFP) sequences, we were able to clearly demonstrate en-docardial fibrosis, tissue inflammation, subendocardial contractile dysfunction, and mural thrombus that correlate with histopathologic findings at autopsy. We believe cardiac MRI is more useful than transthoracic echocardiography in the di-agnosis and management of HES and ultimately may obviate the need for cardiac biopsy to confirm the diagnosis.The Open Cardiovascular Imaging Journal 01/2010; 2.
- Journal of Cardiovascular Magnetic Resonance 01/2010; DOI:10.1186/1532-429X-12-S1-P274 · 5.11 Impact Factor
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ABSTRACT: Eosinophilia may be responsible for cardiac injuries of widely varying severity, from acute myocarditis to endomyocardial fibrosis. In this review, we present both the molecular mechanisms that are responsible for these lesions and their clinical and paraclinical aspects. Numerous aetiologies can lead to severe eosinophilia, but these are mainly represented by hypersensitivity reactions, rheumatological diseases and hypereosinophilic syndrome. Because cardiac involvement may be extremely severe, echocardiography should be always performed in the context of eosinophilia and appropriate therapeutics should be started rapidly in order to limit the progression of the disease. Copyright © 2015 Elsevier Masson SAS. All rights reserved.Archives of cardiovascular diseases 04/2015; 108(4). DOI:10.1016/j.acvd.2015.01.006 · 1.66 Impact Factor