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 Table of Contents  
CURRICULUM IN CARDIOLOGY - IMAGES
Year : 2019  |  Volume : 5  |  Issue : 2  |  Page : 102-104

Endomyocardial fibrosis regression


1 Department of Cardiology, All Institute of Medical Sciences, New Delhi, India
2 Department of Cardiac Radiology, All Institute of Medical Sciences, New Delhi, India
3 Department of Nuclear Medicine, All Institute of Medical Sciences, New Delhi, India
4 Department of Pathology, All Institute of Medical Sciences, New Delhi, India

Date of Submission20-Feb-2019
Date of Decision20-May-2019
Date of Acceptance25-Jun-2019
Date of Web Publication19-Aug-2019

Correspondence Address:
Dr. Karishma Landge
Department of Cardiology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_7_19

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  Abstract 


Endomyocardial fibrosis usually is an end-stage cardiomyopathy. We present a case which was picked up early in a stage with active thrombosis and inflammation using magnetic resonance imaging and DOTANOC scans and treated leading to regression of inflammation and thrombus. We advocate aggressive investigation of all cardiomyopathies to look for treatable causes.

Keywords: Dotanoc, endomyocardial fibrosis, emf, imaging, MRI, regression


How to cite this article:
Landge K, Ojha V, Ganga KP, Kaushik P, Sharma P, Jagia P, Arava S, Chetan P, Gulati G, Ray R, Seth S. Endomyocardial fibrosis regression. J Pract Cardiovasc Sci 2019;5:102-4

How to cite this URL:
Landge K, Ojha V, Ganga KP, Kaushik P, Sharma P, Jagia P, Arava S, Chetan P, Gulati G, Ray R, Seth S. Endomyocardial fibrosis regression. J Pract Cardiovasc Sci [serial online] 2019 [cited 2019 Nov 17];5:102-4. Available from: http://www.j-pcs.org/text.asp?2019/5/2/102/264637



This patient presented with shortness of breath for 6 months. Echocardiogram was suggestive of restrictive cardiomyopathy [Figure 1], [Figure 2], [Figure 3]. There was predominantly left ventricular (LV) apex obliteration with what looked like an irregular apex clot. Since the history was short, the patient underwent a magnetic resonance imaging (MRI), DOTANOC scan for inflammation, and an endomyocardial biopsy. The MRI [Figure 4], [Figure 5], [Figure 6], [Figure 7] suggested an LV apical clot but no evidence of inflammation by the MRI criteria. There was also some right ventricular apical obliteration. The overall impression was endomyocardial fibrosis. His hemogram was normal and there was no eosinophilia. A DOTANOC scan was also done [Figure 8] and [Figure 9]. The DOTANOC scan picked up inflammation underlying the thrombus. This was followed by an endomyocardial biopsy [Figure 10], [Figure 11] that revealed fibrosis but no inflammation. Based on all the findings, he was put on anticoagulation and steroids. With this, the thrombus and inflammation regressed and the patient improved [Figrue 12].
Figure 1: Echocardiogram (four-chamber) showing apex obliteration.

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Figure 2: Echocardiogram: mitral inflow Doppler

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Figure 3: Echocardiogram: Left ventricular outflow Doppler

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Figure 4: Magnetic resonance imaging figures showing apex obliteration and fibrosis.

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Figure 5: Magnetic resonance imaging figures showing thrombus

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Figure 6: Magnetic resonance imaging figures showing apex obliteration and fibrosis getting resolved (arrows pointing to remnants of thrombus).

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Figure 7: Magnetic resonance imaging figures showing fibrosis

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Figure 8: Nuclear Images showing normal perfusion and inflammation

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Figure 9: Nuclear Images showing inflammation.

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Figure 10: Histopathology from endomyocardial biopsy, showing fibrosis.

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Figure 11: Histopathology from endomyocardial biopsy, showing fibrosis (high power slide).

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Endomyocardial fibrosis[1] is usually a condition which is seen as an end-stage disease after the inflammation and thrombotic stage has passed. This patient was unique and we picked him up early. The newer imaging techniques (MRI and DOTANOC scanning)[2],[3] picked up both inflammation and a thrombus which the biopsy[4] did not pick up. Treating him aggressively helping improve a disease which has generally been considered untreatable.

Ethics clearance

Patient permission taken for publication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Grimaldi A, Mocumbi AO, Freers J, Lachaud M, Mirabel M, Ferreira B, et al. Tropical endomyocardial fibrosis: Natural history, challenges, and perspectives. Circulation 2016;133:2503-15.  Back to cited text no. 1
    
2.
Ambale-Venkatesh B, Lima JA. Cardiac MRI: A central prognostic tool in myocardial fibrosis. Nat Rev Cardiol 2015;12:18-29.  Back to cited text no. 2
    
3.
Norikane T, Yamamoto Y, Maeda Y, Noma T, Dobashi H, Nishiyama Y. Comparative evaluation of 18F-FLT and 18F-FDG for detecting cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis. EJNMMI Res 2017;7:69.  Back to cited text no. 3
    
4.
Yin RX, Huang F, Wu JZ. Diagnostic value of endomyocardial biopsy for endomyocardial fibrosis. Int J Clin Exp Pathol 2016;9:11917-22.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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