MR imaging evaluation of pericardial constriction

Case 305: Loeffler Endocarditis

HISTORY

A 27-year-old man was admitted to the emergency department with fever and thoracic pain. In the previous 6 months, the patient lost a substantial amount of weight (12 kg). His family history was negative for cardiac disease. Electrocardiography revealed sinus rhythm and diffuse T-wave inversion. Two-dimensional echocardiography was performed and revealed normal left systolic function (ejection fraction, 60%). Laboratory tests showed elevated levels of high-sensitivity cardiac troponin (1.07 ng/mL; normal value, <0.015 ng/mL), high levels of C-reactive protein (16 mg/dL; normal range, 0-5 mg/dL), and leukocytosis with an eosinophilia level of 8710/μL (normal level, <400/μL). Parasitic and infectious diseases (Toxocara canis, strongyloides, filariasis, cysticercosis, fasciola, trichinella, echinococcosis) were excluded based on blood and fecal test results. Corticosteroid therapy was started, and the patient was dismissed. A few days later, he was readmitted to the emergency department with a headache and suddenly blurred vision. Neurologic and ophthalmologic findings were normal, and MRI of the brain was performed. Cardiac MRI was performed 2 days later and revealed the following quantitative results: (a) left ventricular end-diastolic volume (LVDV) of 165 mL (LVDV/body surface area [BSA], 89 mL/m²; normal range, 64-100 mL/m²), left ventricular end-systolic volume (LVSV) of 80 mL (LVSV/BSA, 43 mL/m²; normal range, 17-39 mL/m²), stroke volume (SV) of 85 mL (SV/BSA, 46 mL/m²; normal range, 43-67 mL/m²), and ejection fraction of 52% and (b) right ventricular end-diastolic volume (RVDV) of 163 mL (RVDV/BSA, 88 mL/m²; normal range, 63-111 mL/m²), right ventricular end-systolic volume (RVSV) of 81 mL (RVSV/BSA, 44 mL/m²; normal range, 32-92 mL/m²), stroke volume (SV) of 82 mL (SV/BSA, 44 mL/m²; normal range, 39-71 mL/m²), and ejection fraction of 50%.

Intra-Cavitary Masses: Rare Presentation of a Common Illness in SAARC Nation

Cardiovascular tuberculosis (TB) is a relatively uncommon manifestation of Mycobacterium tuberculosis infection. TB can affect all three layers of the heart; endocardial tuberculoma is the rarest form. Endocardial tuberculoma, when it occurs, can easily be confused with other common causes of intracardiac mass lesions, especially in echocardiography. Timely diagnosis and appropriate treatment is essential, as only this can lessen the associated morbidity and mortality. Here, a case of cardiovascular TB has been described in a middle-aged woman from the SAARC nation; the woman presented with simultaneous pericardial constriction and multichamber endocardial tuberculoma. Combined pharmacological and surgical approach was successful.