PMC9204136_01
(A) An electrocardiogram on admission. (B) An electrocardiogram revealed a new ST segment depression with T-wave inversion in the precordial leads (arrows). (C) An electrocardiogram before discharge showed the normalization of ST segment and T wave (arrows).
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F1
The electrocardiogram (ECG) revealed sinus rhythm (Figure 1A). The electrocardiographic examination showed a new ST segment depression with T-wave inversion in precordial leads (Figure 1B). Furthermore, an ECG showed the normalization of ST segment and T wave (Figure 1C).
(A) On admission, echocardiography showed that the apex of the left ventricle was filled with a thrombotic mass measuring 3.9 cm x 2.2 cm (arrows). (B) On admission, echocardiographic view after venous injection of an ultrasound contrast agent: thrombus (arrow) at left ventricle apex. (C) Two months after therapy, echocardiography showed a marked reduction in the size of the mass, with a thrombotic mass measuring 6 mm x 13 mm (arrows). (D) Six months after therapy, echocardiography showed that left ventricular thrombus had resolved.
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F2
The most probable diagnosis was Loffler's endocarditis (LE; cardiac involvement in hypereosinophilia) with intracardiac thrombus (Figures 2A,B). Follow-up echocardiogram revealed normal left ventricular size and rapid regression of the left ventricular mass (6 mm x 13 mm, arrow) (Figure 2C). Echocardiogram showed that left ventricular thrombus had resolved (Figure 2D).
(A) CMR four-chamber cine sequence exhibited arc-like region in the LV apex (red arrow). (B-D), Late gadolinium enhancement imaging showed LV apex arc-like unenhanced region (red arrow), and diffuse subendocardial enhancement in LV mid- to apical parts (yellow arrow). The patient was diagnosed with Loeffler's endocarditis based on the typical clinical and imaging features.
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F3
The arc-shaped unenhanced area in the left ventricular cavity and the medical history were consistent with eosinophilic endocarditis with subendocardial thrombosis (Figure 3).
(A,B) 18F-FAPI PET/CT fused image demonstrated the uptake [10.10 (SUVmax), 8.75 (SUVpeak), and 1.92 (SUVmean)] was much higher than that after 2 months of treatment (C,D) [8.40 (SUVmax), 6.91 (SUVpeak), and 1.32 (SUVmean)].
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F4
No other suspected fibrosis with 18F-FAPI accumulation was found (Figures 4A,B). Good clinical response was obtained and after 2 months of treatment, follow-up PET/CT revealed that accumulations of 18F-FAPI in endomyocardial were significantly reduced (Figures 4C,D).