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Case Reports
. 2024 Jun 4;16(6):e61674.
doi: 10.7759/cureus.61674. eCollection 2024 Jun.

Hypereosinophilia and Left Ventricular Thrombus: A Case Report and Literature Review

Aleksan Khachatryan  1 , Hakob Harutyunyan  2 , Mitchell Psotka  3 , Ashot Batikyan  4 , Tufan Cinar  1 , Michael Khorsandi  5 , Joel Alejandro  1 , Vahagn Tamazyan  2 , Margarita Sargsyan  6
Affiliations
Case Reports

Hypereosinophilia and Left Ventricular Thrombus: A Case Report and Literature Review

Aleksan Khachatryan et al. Cureus. .

Abstract

Left ventricular thrombus (LVT) has historically been reported as a complication of acute left ventricular (LV) myocardial infarction. It is most commonly observed in cases of LV systolic dysfunction attributed to ischemic or nonischemic etiologies. Conversely, the occurrence of LVT in normal LV systolic function is an exceptionally rare presentation and is predominantly associated with conditions such as hypereosinophilic syndrome (HES), cardiac amyloidosis, left ventricular noncompaction, hypertrophic cardiomyopathy (HCM), hypercoagulability states, immune-mediated disorders, and malignancies. Notably, hypereosinophilia (HE) has been linked with thrombotic events. Intracardiac thrombus is a well-known complication of eosinophilic myocarditis (EM) or Loeffler endomyocarditis, both of which are considered clinical manifestations of HES. We present a case of a 63-year-old male with normal LV systolic function, HE, and noncontributory hypercoagulability workup, who presented with thromboembolic complications arising from LVT. Interestingly, the diagnostic evaluation for EM and Loeffler endocarditis was nonconfirmatory. Additionally, we performed a literature review to delineate all similar cases. This article also outlines the pathophysiology, diagnosis, and treatment approaches for hypereosinophilic cardiac involvement with a specific focus on LVT.

Keywords: absolute eosinophil count; arterial thromboembolism; cardiac magnetic resonance imaging (cmri); endomyocardial biopsy; eosinophilic myocarditis; hypereosinophilia; hypereosinophilia syndrome; left ventricular thrombosis; loeffler endomyocarditis; restrictive cardiomyopathy.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The TTE nine months ago demonstrated intraventricular thrombi when the patient presented with multiple thromboembolic complications
(a and b) LV inferolateral wall thrombus on parasternal long and short axis views, respectively. (c and d) Apical and inferolateral floating thrombi on apical four-chamber view TTE, transthoracic echocardiogram; LV, left ventricular
Figure 2
Figure 2. The ECG from the current hospitalization
The blue arrows indicate the presence of low voltage in the limb leads, and the red arrows indicate T-wave inversions in III, aVF, and V6 leads.
Figure 3
Figure 3. The TTE from the current hospitalization
(a) Mildly thickened anterior mitral valve leaflet. (b) Severe left atrial dilation. (c and d) Interventricular septal flattening with a "D" shape configuration and severe right ventricular dilation, respectively TTE: transthoracic echocardiogram
See this image and copyright information in PMC

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