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Hypereosinophilia and Left Ventricular Thrombus: A Case Report and Literature Review

Aleksan Khachatryan1, Hakob Harutyunyan2, Mitchell Psotka3

  • 1Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, USA.

Cureus
|July 5, 2024
PubMed

Insights

Left ventricular thrombus (LVT) is rare in normal heart function. This case highlights hypereosinophilia (HE) as a potential cause of LVT and thromboembolism, even without confirmed eosinophilic myocarditis.

Area of Science:

  • Cardiology
  • Hematology
  • Internal Medicine

Background:

  • Left ventricular thrombus (LVT) is typically a complication of left ventricular (LV) systolic dysfunction from myocardial infarction.
  • However, LVT can occur in normal LV systolic function, associated with rare conditions like hypereosinophilic syndrome (HES).
  • Hypereosinophilia (HE) is linked to thrombotic events, with intracardiac thrombus being a known complication of eosinophilic myocarditis (EM), a manifestation of HES.

Observation:

  • A 63-year-old male with normal LV systolic function presented with thromboembolic complications.
  • The patient had hypereosinophilia (HE) but a noncontributory hypercoagulability workup.
  • Diagnostic evaluation for EM and Loeffler endocarditis was inconclusive.

Findings:

  • The patient developed left ventricular thrombus (LVT) despite normal LV systolic function.
  • Hypereosinophilia (HE) was present, but specific diagnoses of eosinophilic myocarditis (EM) or Loeffler endomyocarditis were not confirmed.
  • A literature review identified similar rare cases linking HE to LVT.

Implications:

  • This case underscores that LVT with normal LV systolic function can be associated with hypereosinophilia (HE), even without definitive evidence of eosinophilic myocarditis (EM).
  • It highlights the importance of considering HE in the etiological workup of LVT, especially in unexplained thromboembolic events.
  • Further research into the pathophysiology and diagnostic criteria for hypereosinophilic cardiac involvement is warranted to improve patient outcomes.

Keywords:
absolute eosinophil countarterial thromboembolismcardiac magnetic resonance imaging (cmri)endomyocardial biopsyeosinophilic myocarditishypereosinophiliahypereosinophilia syndromeleft ventricular thrombosisloeffler endomyocarditisrestrictive cardiomyopathy

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