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Forme fruste of isolated right ventricular endomyocardial fibrosis: a case report.

Bunte M, Liao K, Manivel JC, Missov E - J Med Case Rep (2014)

Bottom Line: It is endemic of tropical climates where it is the most common cause of restrictive cardiomyopathy in the second and fourth decades of life.A forme fruste of the disease is thought to be present in temperate climates where the diagnosis remains exceedingly rare.We conclude that endomyocardial fibrosis should be included in the differential diagnosis of apical cardiomyopathies in patients from temperate climates.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiology, University of Minnesota Medical Center, Minneapolis, MN 55455, USA. misso001@umn.edu.

ABSTRACT

Introduction: Endomyocardial fibrosis is a neglected tropical disease of unknown etiology and poor prognosis. It is endemic of tropical climates where it is the most common cause of restrictive cardiomyopathy in the second and fourth decades of life. A forme fruste of the disease is thought to be present in temperate climates where the diagnosis remains exceedingly rare.

Case presentation: We describe a case of isolated right ventricular endomyocardial fibrosis in a 27-year-old Caucasian man from a temperate climate who presented initially with frank hemoptysis and pulmonary thromboembolic disease. We further describe the approach utilized in the diagnosis, the surgical treatment and the outcome of the disease.

Conclusions: We conclude that endomyocardial fibrosis should be included in the differential diagnosis of apical cardiomyopathies in patients from temperate climates.

No MeSH data available.


Related in: MedlinePlus

Histopathological findings. Markedly thickened fibrous endocardium (upper right) overlies normal myocardium (lower left). A layer of arterioles, venules and capillaries is seen at the interphase between the myocardium and thickened endocardium. Eosinophils are not present. (Hematoxylin-eosin stain; original magnification, ×400).
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Figure 2: Histopathological findings. Markedly thickened fibrous endocardium (upper right) overlies normal myocardium (lower left). A layer of arterioles, venules and capillaries is seen at the interphase between the myocardium and thickened endocardium. Eosinophils are not present. (Hematoxylin-eosin stain; original magnification, ×400).

Mentions: A 27-year-old Caucasian man presented with frank hemoptysis preceded by a two-month history of shortness of breath and non-productive cough. Prior to this subacute illness, he was healthy, had no travel history, and was a long-distance endurance athlete. An intravenously-contrasted computerized tomogram of the chest revealed bilateral pulmonary emboli and a filling defect within his right ventricle. Duplex lower extremity ultrasonography was negative for deep vein thrombosis. Transesophageal echocardiography revealed a mass at his right ventricular apex spanning proximally as pedunculated extensions through the tricuspid valve. Gadolinium-enhanced cardiac magnetic resonance imaging (MRI) confirmed a complex mass obliterating his right ventricular apex, insinuated between the chordae tendineae of the tricuspid valve and terminating in lobular stalks (Additional file 1). Surgical excision was recommended as the mass was felt to represent high risk for recurrent embolic events. The gross appearance of the mass was smooth, yellow and lobulated (Figure 1). Two distinct heads projected through the tricuspid valve and extensively insinuated between the chordae tendineae, requiring right ventricular endocardectomy with excision and replacement of the tricuspid valve. On histopathological examination, normal myocardium was covered by thickened fibrous endocardium with dense collagen, rare non-specific inflammatory cells with no eosinophils and a layer of arterioles, small veins and capillaries at the interphase with the myocardium (Figure 2). These findings are pathognomonic of endomyocardial fibrosis.


Forme fruste of isolated right ventricular endomyocardial fibrosis: a case report.

Bunte M, Liao K, Manivel JC, Missov E - J Med Case Rep (2014)

Histopathological findings. Markedly thickened fibrous endocardium (upper right) overlies normal myocardium (lower left). A layer of arterioles, venules and capillaries is seen at the interphase between the myocardium and thickened endocardium. Eosinophils are not present. (Hematoxylin-eosin stain; original magnification, ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4008263&req=5

Figure 2: Histopathological findings. Markedly thickened fibrous endocardium (upper right) overlies normal myocardium (lower left). A layer of arterioles, venules and capillaries is seen at the interphase between the myocardium and thickened endocardium. Eosinophils are not present. (Hematoxylin-eosin stain; original magnification, ×400).
Mentions: A 27-year-old Caucasian man presented with frank hemoptysis preceded by a two-month history of shortness of breath and non-productive cough. Prior to this subacute illness, he was healthy, had no travel history, and was a long-distance endurance athlete. An intravenously-contrasted computerized tomogram of the chest revealed bilateral pulmonary emboli and a filling defect within his right ventricle. Duplex lower extremity ultrasonography was negative for deep vein thrombosis. Transesophageal echocardiography revealed a mass at his right ventricular apex spanning proximally as pedunculated extensions through the tricuspid valve. Gadolinium-enhanced cardiac magnetic resonance imaging (MRI) confirmed a complex mass obliterating his right ventricular apex, insinuated between the chordae tendineae of the tricuspid valve and terminating in lobular stalks (Additional file 1). Surgical excision was recommended as the mass was felt to represent high risk for recurrent embolic events. The gross appearance of the mass was smooth, yellow and lobulated (Figure 1). Two distinct heads projected through the tricuspid valve and extensively insinuated between the chordae tendineae, requiring right ventricular endocardectomy with excision and replacement of the tricuspid valve. On histopathological examination, normal myocardium was covered by thickened fibrous endocardium with dense collagen, rare non-specific inflammatory cells with no eosinophils and a layer of arterioles, small veins and capillaries at the interphase with the myocardium (Figure 2). These findings are pathognomonic of endomyocardial fibrosis.

Bottom Line: It is endemic of tropical climates where it is the most common cause of restrictive cardiomyopathy in the second and fourth decades of life.A forme fruste of the disease is thought to be present in temperate climates where the diagnosis remains exceedingly rare.We conclude that endomyocardial fibrosis should be included in the differential diagnosis of apical cardiomyopathies in patients from temperate climates.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiology, University of Minnesota Medical Center, Minneapolis, MN 55455, USA. misso001@umn.edu.

ABSTRACT

Introduction: Endomyocardial fibrosis is a neglected tropical disease of unknown etiology and poor prognosis. It is endemic of tropical climates where it is the most common cause of restrictive cardiomyopathy in the second and fourth decades of life. A forme fruste of the disease is thought to be present in temperate climates where the diagnosis remains exceedingly rare.

Case presentation: We describe a case of isolated right ventricular endomyocardial fibrosis in a 27-year-old Caucasian man from a temperate climate who presented initially with frank hemoptysis and pulmonary thromboembolic disease. We further describe the approach utilized in the diagnosis, the surgical treatment and the outcome of the disease.

Conclusions: We conclude that endomyocardial fibrosis should be included in the differential diagnosis of apical cardiomyopathies in patients from temperate climates.

No MeSH data available.


Related in: MedlinePlus