Thread by @Talalkfo

59 y with lymphoma, had an echo prior to chemotherapy.

patient reported mild lower limb edema over the prior month. Absolute Eosinophil Count 5.1 K/uL. ECG sinus tachycardia with LAE- no inverted T waves noted.

CMR showing a “double V” sign, which includes a normal myocardium, followed by a thickened enhanced endomyocardial layer, and then an overlying apical thrombus. This is a typical finding of Loeffler's endocarditis (Eosinophilic myocarditis).

Long TI confirming biventricular thrombi.

The patient was eventually diagnosed with paraneoplastic reactive hypereosinophilic syndrome (HES) manifesting as Loeffler endocarditis.

The ability of tissue characterization provided by CMR was crucial for establishing the diagnosis HES and R/O primary cardiac lymphoma. Demonstrating the significant clinical impact CMR provides, from the choice of the chemotherapy regimen to starting anticoagulation.

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