The Open Cardiovascular Imaging Journal

2010, 2 : 10-13
Published online 2010 August 06. DOI: 10.2174/1876538601002010010
Publisher ID: TOCARIJ-2-10

The Role of Cardiac MRI in the Diagnosis and Management of Loeffler’s Endocarditis: A Case Report with Clinical and Pathologic Correlation

K. Chad Hilty , James A. Koonce , Roger W. Ston , Luis Ramos-Duran , Ashley L. Pyle , Nicholas I. Batalis , Andrew D. Hardie and Marian H. Taylor
e Medical University of South Carolina, Cardiology Division, 25 Courtenay Drive, ART 7058, Box 592, Charleston, SC 29425, USA.

ABSTRACT

Cardiac manifestations of the hypereosinophilic syndrome (HES), first described by Loeffler in 1936, are rare and difficult to image. We report a fatal case of Loeffler’s endocarditis in a 71 year-old female with a history of asthma. An initial transthoracic echocardiogram demonstrated normal wall motion and a suggestion of left ventricular apical thrombus. However, using cardiac MRI with ultra fast inversion-recovery (IR) delayed enhancement, gradient recalled echo (GRE) grid-tagging and cine steady-state free precession (SSFP) sequences, we were able to clearly demonstrate endocardial fibrosis, tissue inflammation, subendocardial contractile dysfunction, and mural thrombus that correlate with histopathologic findings at autopsy. We believe cardiac MRI is more useful than transthoracic echocardiography in the diagnosis and management of HES and ultimately may obviate the need for cardiac biopsy to confirm the diagnosis.

Keywords:

Loeffler’s, hypereosinophilic syndrome, MRI, endocarditis.