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Loeffler Endocarditis: Multimodality Imaging of a Common Cardiac Phenotype in Distinct Hypereosinophilic Syndromes
Tooba Salar1, Scott Feitell1, Vishal Parikh1
1Rochester General Hospital, Rochester, New York, USA.
Insights
Loeffler endocarditis, a heart condition linked to hypereosinophilic syndromes, presents challenges in early diagnosis. Imaging is key for identifying cardiac damage and guiding targeted therapies for better patient outcomes.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- Loeffler endocarditis is a severe cardiac manifestation of hypereosinophilic syndromes.
- It involves endomyocardial fibrosis and intracardiac thrombosis.
- Nonspecific symptoms often delay diagnosis.
Background:
Loeffler endocarditis is a late manifestation of hypereosinophilic syndromes characterized by endomyocardial fibrosis and intracardiac thrombosis. Early recognition is essential yet challenging because presentation is often nonspecific.
Case Summary:
Case 1 involved a 43-year-old man with long-standing atopy and persistent eosinophilia who presented with heart failure symptoms. Echocardiography demonstrated biventricular apical thrombi, and cardiac magnetic resonance confirmed ventricular thrombi and revealed diffuse subendocardial late gadolinium enhancement confirming fibrotic-stage disease. High-dose corticosteroids produced rapid hematologic response, and anticoagulation was initiated. Case 2 involved a 38-year-old man who was admitted for abdominal pain and incidentally found to have eosinophilia and right ventricular apical infiltration. Cardiac magnetic resonance established the diagnosis of Loeffler endocarditis. Molecular testing identified FIP1L1-PDGFRA-positive myeloproliferative hypereosinophilic syndrome. Eosinophil counts normalized promptly with imatinib.
Conclusions:
These cases illustrate a final common cardiac phenotype arising from diverse causes of hypereosinophilia. Imaging was central not only for diagnosis and staging, but also for prompting systemic investigation and directing targeted therapy.
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