824 Image Focus IMAGE FOCUS doi:10.1093/ehjci/jey032 Online publish-ahead-of-print 23 February 2018 .................................................................................................................................................... Multimodality imaging in endomyocardial fibrosis associated with Hodgkin lymphoma 1 1 2 2 3 Petr Kuchynka , Tomas Palecek *, Lukas Lambert , Martin Masek , and Vaclav Ptacnik 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic; Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic; and Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic * Corresponding author. Tel: 1 420 2 24962634; Fax: 1420 2 24912154. E-mail: firstname.lastname@example.org Endomyocardial fibrosis (EMF) repre- sents a rare type of restrictive cardiomy- opathy in Europe. This entity is of heterogeneous aetiology and is usually associated with hypereosinophilia in per- ipheral blood. We describe an unusual case of EMF associated with Hodgkin lymphoma. A 62-year-old man with a history of ax- illary lymphadenopathy and peripheral hypereosinophilia was admitted to our department for congestive heart failure. Transthoracic echocardiography showed non-dilated left ventricle with normal sys- tolic function and restrictive filling pat- tern. In the apical segments of both ventricles, obliterating pathological masses highly suspicious for EMF were present (Panel A, Supplementary data on- line, Video S1). This cardiac disorder was subsequently confirmed with cardiac magnetic resonance imaging depicting not only the pathological ventricular masses but also showing late gadolinium en- hancement pattern typical for EMF (Panel B, Supplementary data online, Video S2). To clarify the cause of hypereo- sinophilia and lymphadenopathy, positron emission tomography–computed tomography was performed and generalized lymphadenopathy typical for lymphoproliferative haematological disorder was found. Regarding the heart involvement, physiological accumulation of 18-flu- oro-deoxyglucose in the myocardium and its absence in the left ventricular mass was shown (Panel C). The patient underwent surgical extir- pation of the enlarged lymph node from the right axilla and Hodgkin lymphoma was diagnosed. After six cycles of chemotherapy including corticosteroids complete remission was observed. During this oncological treatment the amount of pathological ventricular masses signifi- cantly decreased; however, highly mobile pathological mass in the left ventricular apex was still present (Panel D, Supplementary data online, Video S3) and the patient experienced embolization to the right central retinal artery despite permanent adequate anticoagulation. In order to prevent further embolic event, surgical resection of pathological left ventricular mass was successfully performed. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: email@example.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/7/824/4907938 by Ed 'DeepDyve' Gillespie user on 26 June 2018
European Heart Journal – Cardiovascular Imaging – Oxford University Press
Published: Feb 23, 2018
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