Cardiac Magnetic Resonance Imaging to Detect Right Atrial Thrombus in Right Ventricular Endomyocardial Fibrosis

Abstract

Tropical endomyocardial fibrosis (EMF) is endemic in southern districts of Kerala state in India, and sporadic cases are reported from other parts of Kerala. Transthoracic echocardiogram (TTE) is the initial imaging tool and is diagnostic for this condition. The inherent limitation of TTE is its limited sensitivity in the detection of intracardiac thrombus. Transthoracic echocardiography, contrast-enhanced cardiac computed tomography, and cardiac magnetic resonance imaging (CMR) are the imaging modalities for the detection of intracardiac thrombus. This report describes a 46-year-old male with right ventricular EMF (RVEMF) who presented with right heart failure. The TTE diagnosed RVEMF but failed to demonstrate the right atrial thrombus which was clearly seen on CMR. The merits of different imaging modalities for the detection of intracardiac thrombus are discussed.

A Review of the Complications of Endomyocardial Fibrosis along with Their Physiological Compromise

“…Treatment strategies include heart failure control with diuretics or angiotensin-converting enzyme (ACE) inhibitors, along with aspirin unless the patient is unresponsive to pharmacological therapy. In severe cases, invasive interventions such as valvular repair/replacement and endocardectomy have been traditionally employed and have shown positive outcomes [13][14][15][16][17][18]. In critical cases where the patient's physiology is severely compromised, heart transplantation has been reported as a viable option.…”