Imaging Diagnosis for Left Ventricular Thrombosis in Idiopathic Hypereosinophilic Syndrome

Abstract

Idiopathic hypereosinophilic syndrome (IHES) is a rare disease that is frequently associated with cardiac thrombosis and endocardial wall thickness.This case report describes 2 patients who had IHES associated with left ventricular (LV) thrombi. The patients’ symptoms are atypical. Peripheral blood and bone marrow tests showed markedly elevated eosinophils. Electrocardiography showed ischemic changes in both patients. Negative computed tomography (CT) angiography excluded coronary artery stenosis. Transthoracic echocardiography (TTE), conventional multislice spiral CT, gemstone spectral CT, and cardiac magnetic resonance imaging were used to identify the LV intraluminal thrombus and endocardial thickening, and the diagnostic values of each imaging method were analyzed and compared.These patients were clinically diagnosed as “IHES, LV thrombosis, NYHA heart function classification I.”Both patients received oral prednisone and warfarin therapy.At 5 month follow-up, TTE rechecks showed that the size of the LV thrombotic lesion was reduced in the first case but substantially increased in the second case.

Usefulness of three‐dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis

“…We present a patient with Loeffler endocarditis in whom 3DTTE and 3DTEE were useful in assessing the four cardiac valves. We also summarize in tabular form the clinical and diagnostic features, prognosis, and management of HES as described in the literature (Tables ) …”

“…Cardiac CT scan 4,5 • Can help in excluding CAD as a potential cause for the mural thrombosis • Can assess location, size, and morphology of thrombus but may not detect the boundary between endocardium and thrombus USA) and an S5-1 transducer showed thickening of the tips of the mitral valve (MV) leaflets, restricted motion of the posterior mitral leaflet (PML), and severe mitral regurgitation (MR) by color Doppler.…”

Cardiopulmonary and Gastrointestinal Manifestations of Eosinophil- associated Diseases and Idiopathic Hypereosinophilic Syndromes: Multimodality Imaging Approach

“…Transthoracic echocardiography is the most widely used imaging modality to diagnose endomyocarditis in patients with hypereosinophilic syndrome. Typical findings of associated heart involvement include endocardial thickening, cardiac mural thrombus, and restrictive diastolic (filling) dysfunction (58,59). However, the major pitfall of transthoracic echocardiography is its inherent low tissue resolution, which may not depict the interface between a thrombotic lesion and its attachment to the thickened underlying endocardium.…”