Cardiac involvement in hypereosinophilic syndrome

Area of Science:

• Cardiology
• Hematology
• Medical Imaging

Background:

• Hypereosinophilic syndrome (HES) is a rare disorder characterized by persistent eosinophilia.
• Cardiac involvement in HES typically manifests as apical endocardial fibrosis or thrombus formation.
• Left ventricular mural thrombus is an uncommon cardiac manifestation of HES.

Purpose of the Study:

• To report an unusual case of a large left ventricular mural thrombus in a pediatric patient with HES.
• To highlight the diagnostic utility of cardiac magnetic resonance (CMR) imaging in characterizing cardiac involvement in HES.
• To demonstrate how CMR findings can guide therapeutic decisions in complex HES cases.

Main Methods:

• A 9-year-old boy with HES and an abnormal echocardiogram underwent cardiac magnetic resonance (CMR) imaging.
• CMR imaging was utilized to evaluate a large mass on the inferolateral wall of the left ventricle.
• The imaging findings were correlated with clinical presentation and echocardiographic data.

Main Results:

• CMR confirmed a large mural thrombus (0.9 cm × 4.2 cm) on the inferolateral wall of the left ventricle.
• The thrombus was identified in the intermediate thrombotic stage, an unusual finding in HES cardiac involvement.
• CMR elucidated the etiology of severe mitral regurgitation secondary to the mural thrombus.

Conclusions:

• Cardiac magnetic resonance (CMR) imaging is highly sensitive and specific for diagnosing and staging cardiac involvement in HES.
• This case demonstrates an atypical location and presentation of cardiac thrombus in HES.
• CMR imaging plays a crucial role in guiding management strategies for HES-related cardiac complications.