Cardiac magnetic resonance imaging of eosinophilic endomyocardial disease.
Idiopathic hypereosinophilic syndrome (HES) is rare and frequently involves the heart with development of endomyocardial fibrosis, a characteristic restrictive cardiomyopathy. Non-invasive diagnosis is frequently challenging. Recent developments in cardiac magnetic resonance (CMR) imaging techniques offer potential for improved detection and characterization of this entity. We describe the use of contrast-enhanced CMR to demonstrate thrombus, endomyocardial fibrosis and inflammation in eosinophilic endomyocardial disease. A three-layered appearance consisting of normal myocardium, thickened fibrotic endocardium with inflammatory exudate, and overlying thrombus was seen on cine-images. Post-contrast perfusion and delayed enhancement images confirmed the presence and location of endomyocardial fibrosis and thrombus. CMR is an important and powerful addition to current non-invasive diagnostic tools for the clinical diagnosis of eosinophilic endomyocardial disease, and may potentially obviate the need for cardiac biopsy in the future.
Syed
Imran S
IS
Martinez
Matthew W
MW
Feng
Da-Li
DL
Glockner
James F
JF
D003287:Contrast Media / Q000494:pharmacology; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA