Cardiac magnetic resonance imaging of eosinophilic endomyocardial disease

Idiopathic hypereosinophilic syndrome (HES) is rare and frequently involves the heart with development of endomyocardial fibrosis, a characteristic restrictive cardiomyopathy. Non-invasive diagnosis is frequently challenging. Recent developments in cardiac magnetic resonance (CMR) imaging techniques offer potential for improved detection and characterization of this entity. We describe the use of contrast-enhanced CMR to demonstrate thrombus, endomyocardial fibrosis and inflammation in eosinophilic endomyocardial disease. A three-layered appearance consisting of normal myocardium, thickened fibrotic endocardium with inflammatory exudate, and overlying thrombus was seen on cine-images. Post-contrast perfusion and delayed enhancement images confirmed the presence and location of endomyocardial fibrosis and thrombus. CMR is an important and powerful addition to current non-invasive diagnostic tools for the clinical diagnosis of eosinophilic endomyocardial disease, and may potentially obviate the need for cardiac biopsy in the future.