Clinical image - unknown part II

Figure 2. The answer is: d) endomyocardial fibrosis Cross sections of the heart (Figure 2) at the level of the papillary muscles and the left ventricular apex demonstrate marked thickening of the endocardium (white arrow) with obliteration of the cardiac apex by densely calcified thrombus (black arrow). No eosinophils were identified on microscopic sections. Endomyocardial fibrosis and eosinophilic cardiomyopathy are thought to be associated with eosinophilia and result in a progressive restrictive cardiomyopathy with a very poor prognosis. Typical echocardiographic features include thickening of the inferior basal left ventricular wall with endocardial thickening, apical obliteration and preserved left ventricular function. Eosinophilia was likely suppressed in this patient by her immunosuppressive regimen after kidney transplantation.

ACC CURRENT JOURNAL REVIEW May/Jun 2001

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