PMC5088543_01
Chest roentgenograms and electrocardiograms. A chest roentgenogram (a) from the first admission appeared normal, and an electrocardiogram (b) that was taken at the same time demonstrated nonspecific ST-T changes. However, the chest roentgenogram from the second admission (c) showed pleural effusion and infiltration, which was suggestive of eosinophilic pneumonia and heart failure. An electrocardiogram from the second admission showed almost no changes.
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A chest radiograph appeared normal (Fig. 1a). A 12-lead electrocardiogram showed non-specific changes, which suggested mild left ventricular (LV) hypertrophy (Fig. 1b). A chest radiograph revealed pulmonary congestion and infiltration (Fig. 1c).
Routine echocardiography from the patient's first admission. Parasternal (a) and short-axis (b) views in the early stage of eosinophilic myocarditis show a superficial layer on the endocardium, suggesting a thrombus (arrow).
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Echocardiography showed the mild thickening of the LV wall and minimal pericardial effusion behind the LV posterior wall (Fig. 2).
Left ventriculography from the patient's first admission. The diastolic (a) and systolic (b) phases show an abnormal pattern of contrast medium at the apex, with normal systolic function.
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However, left ventriculography (LVG) showed the abnormal pooling of contrast medium within the myocardium (Fig. 3).
Echocardiography at the time of the diagnosis of Churg-Strauss syndrome and after the initiation of treatment. The echocardiogram from the third day of the second admission (a) demonstrates a mural thrombus (white arrow) occupying the left ventricular cavity. Color Doppler echocardiography (b) shows two blood flows from the endocardium of the lateral wall. On the 20th day during steroid and anticoagulation therapy, the superficial layer of the thrombus was detached from the endocardium (c). On the 91st day, the thrombus had disappeared (d).
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Echocardiography showed a diffuse mural thrombus-like echo in the LV endocardium (Fig. 4a), although M-mode measurement demonstrated normal systolic function with an ejection fraction of 74%. Color Doppler echocardiography showed unusual blood flow from the endocardium and mural thrombus into the LV cavity during systole (Fig. 4b). During anticoagulation therapy, echocardiography revealed that the mural thrombus was detached from the LV endocardium (Fig. 4c). We performed echocardiography at our outpatient clinic on the 91st day and confirmed that the thrombus had disappeared (Fig. 4d).