Atypical Presentation of Eosinophilic Endomyocardial Disease

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Presentation transcript:

Atypical Presentation of Eosinophilic Endomyocardial Disease Lori A. Blauwet, MD, Jerome F. Breen, MD, William D. Edwards, MD, Kyle W. Klarich, MD Mayo Clinic Proceedings Volume 80, Issue 8, Pages 1078-1084 (August 2005) DOI: 10.4065/80.8.1078 Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Transesophageal echocardiograms showing a 2.9-cm thrombus occupying the apex of the left ventricle (LV). Left, Four-chamber view. Right, Two-chamber view. LA = left atrium; RA = right atrium; RV = right ventricle. Mayo Clinic Proceedings 2005 80, 1078-1084DOI: (10.4065/80.8.1078) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Magnetic resonance images of the heart. Left, Spin-echo (black-blood) sequence reveals a slow flow–related signal artifact and a suspected mass (arrow) in the left ventricular apex. Right, On cine (white-blood) sequence, the suspected mass appears to be only a thickening of the akinetic apical myocardium. Mayo Clinic Proceedings 2005 80, 1078-1084DOI: (10.4065/80.8.1078) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Cardiac computed tomographic images clearly identify a noncalcified mass filling much of the left ventricular apex. Left, Most of the mass (asterisk) shows no contrast enhancement, although a rim of hyperenhancement (arrow) is seen on delayed image. Right, The mass abuts and is adherent to the myocardium but does not appear to invade it. No left ventricular aneurysm or diverticulum is present. Mayo Clinic Proceedings 2005 80, 1078-1084DOI: (10.4065/80.8.1078) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Surgical resection of left ventricular thrombus. Left, Opening the left ventricular myocardium. Right, Gross specimen of resected left ventricular thrombus. Mayo Clinic Proceedings 2005 80, 1078-1084DOI: (10.4065/80.8.1078) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 5 Immunofluorescence photomicrographs of left ventricular mural thrombus showing eosinophilic granule major basic protein. Left, Section stained with affinity-purified rabbit anti–human major basic protein shows extensive diffuse deposition of cytotoxic major basic protein from degranulated eosinophils (original magnification ×160). Right, Old degenerating thrombus with rare intact eosinophils (hematoxylin-eosin, original magnification ×150). Mayo Clinic Proceedings 2005 80, 1078-1084DOI: (10.4065/80.8.1078) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions