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Biventricular thrombus in hypereosinophilic syndrome presenting with shortness of breath

View Article: PubMed Central - PubMed

ABSTRACT

A 48 years old male presented to clinic with 12 months of low grade fever with shortness of breath which has progressively worsened with no associated weight loss, night sweats or loss of appetite. There was no prior history of chronic illness before the current illness. Laboratory workup revealed a high white blood cell count with predominant eosinophils. Chest X-ray was normal. Transthoracic echocardiography and Cardiac Magnetic Resonance showed biventricular thrombi. On further extensive workup the findings were consistent with hypereosinophilic syndrome. The patient was started on oral steroids, hydroxyurea, imatanib mesylate and oral anticoagulation. The patient responded to the treatment with complete resolution of his symptoms over the course of few months. The repeat Echocardiogram after a year showed normal left ventricular systolic and diastolic function with complete resolution of biventricular thrombi.

No MeSH data available.


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Transthoracic ECHO, showing large thrombi in ventricles.
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fig1: Transthoracic ECHO, showing large thrombi in ventricles.

Mentions: Initial work up revealed high WBC (22 × 109/L) count with predominant Eosinophils of 43%. Hemoglobin and platelets were within normal limits. ESR was 53 mm/h. Chest x-ray was negative for pulmonary edema, infiltrates or fibrotic changes. We considered bronchial asthma, eosinophilic pneumonia, parasitic infection, churg-strauss syndrome, malignancies and Hypereosinophilic syndrome as differential diagnoses to explain this eosinophilia. There were no parasitic eggs or larvae in his stool and results of sera anti-Aspergillus antibody tests were negative (to exclude parasitic infection). Spirometry was negative for any obstructive or restrictive lung pathology. Computed tomography (CT) scan detected no abnormalities in the lungs (eosinophilic pneumonia was excluded) liver, gall bladder, pancreas and kidneys. Among six diagnostic criteria for churg-strauss syndrome (CSS), only eosinophilia was fulfilled. In addition, tests for anti-neutrophil cytoplasmic antibodies (ANCAs) were negative. Therefore, CSS was unlikely. Tumor markers were measured, carcinoembryonic antigen (CEA), Squamous cell carcinoma (SCC), a-fetoprotein (AFP) were all negative. Echocardiography (ECHO) was done to rule out any possible causes of shortness of breath in this patient, ECHO revealed normal left ventricular systolic function but with Grade II left ventricular diastolic dysfunction and no valvular pathology (Fig. 1). ECHO also revealed echogenic densities in right and left ventricular apices, those were consistent with apical thrombi. Due to these findings cardiac Magnetic resonance imaging (CMRI) was done to confirm the echo findings, CMRI showed normal left ventricular volumes with normal left ventricular systolic function, a thin rim of left ventricular apical thrombus and findings on late gadolinium images were consistent with the diagnosis of endomyocardial fibrosis secondary to HES (Fig. 2). Further evaluation of eosinophilia including.


Biventricular thrombus in hypereosinophilic syndrome presenting with shortness of breath
Transthoracic ECHO, showing large thrombi in ventricles.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121253&req=5

fig1: Transthoracic ECHO, showing large thrombi in ventricles.
Mentions: Initial work up revealed high WBC (22 × 109/L) count with predominant Eosinophils of 43%. Hemoglobin and platelets were within normal limits. ESR was 53 mm/h. Chest x-ray was negative for pulmonary edema, infiltrates or fibrotic changes. We considered bronchial asthma, eosinophilic pneumonia, parasitic infection, churg-strauss syndrome, malignancies and Hypereosinophilic syndrome as differential diagnoses to explain this eosinophilia. There were no parasitic eggs or larvae in his stool and results of sera anti-Aspergillus antibody tests were negative (to exclude parasitic infection). Spirometry was negative for any obstructive or restrictive lung pathology. Computed tomography (CT) scan detected no abnormalities in the lungs (eosinophilic pneumonia was excluded) liver, gall bladder, pancreas and kidneys. Among six diagnostic criteria for churg-strauss syndrome (CSS), only eosinophilia was fulfilled. In addition, tests for anti-neutrophil cytoplasmic antibodies (ANCAs) were negative. Therefore, CSS was unlikely. Tumor markers were measured, carcinoembryonic antigen (CEA), Squamous cell carcinoma (SCC), a-fetoprotein (AFP) were all negative. Echocardiography (ECHO) was done to rule out any possible causes of shortness of breath in this patient, ECHO revealed normal left ventricular systolic function but with Grade II left ventricular diastolic dysfunction and no valvular pathology (Fig. 1). ECHO also revealed echogenic densities in right and left ventricular apices, those were consistent with apical thrombi. Due to these findings cardiac Magnetic resonance imaging (CMRI) was done to confirm the echo findings, CMRI showed normal left ventricular volumes with normal left ventricular systolic function, a thin rim of left ventricular apical thrombus and findings on late gadolinium images were consistent with the diagnosis of endomyocardial fibrosis secondary to HES (Fig. 2). Further evaluation of eosinophilia including.

View Article: PubMed Central - PubMed

ABSTRACT

A 48 years old male presented to clinic with 12 months of low grade fever with shortness of breath which has progressively worsened with no associated weight loss, night sweats or loss of appetite. There was no prior history of chronic illness before the current illness. Laboratory workup revealed a high white blood cell count with predominant eosinophils. Chest X-ray was normal. Transthoracic echocardiography and Cardiac Magnetic Resonance showed biventricular thrombi. On further extensive workup the findings were consistent with hypereosinophilic syndrome. The patient was started on oral steroids, hydroxyurea, imatanib mesylate and oral anticoagulation. The patient responded to the treatment with complete resolution of his symptoms over the course of few months. The repeat Echocardiogram after a year showed normal left ventricular systolic and diastolic function with complete resolution of biventricular thrombi.

No MeSH data available.


Related in: MedlinePlus