Intracardiac Thrombus in Leukemia: Role of Cardiac Magnetic Resonance Imaging in Eosinophilic Myocarditis

Figure 1. Transthoracic echocardiography, (A) apical four-chamber view and (B) apical two-chamber view, showing apical isoechoic density (asterisk) suspicious for left ventricular mural thrombus.

Figure 2. Cardiac magnetic resonance, (A) cine steady-state free precession (SSFP) four-chamber view and (B) cine SSFP three-chamber view, showing a large 2.7-cm apical mass (asterisk) in the setting of normal wall motion and overall preserved left ventricular function and small pericardial effusion. (C) T2-weighted fast spin echo sequences with evidence of hyperintense signal in the apical and inferior myocardial wall adjacent to the thrombus suggestive of myocardial inflammation (blue arrow). (D) Resting first-pass perfusion images did not reveal any gadolinium uptake in the mass, suggesting absence of vascularity. Postgadolinium inversion recovery sequences performed with high inversion times (600 ms) in (E) four-chamber view and (F) two-chamber view revealed lack of delayed enhancement and homogeneously black appearance consistent with thrombus and adjacent apical myocardial inflammation.

Figure 3. Cardiac magnetic resonance, (A) cine steady-state free precession (SSFP) four-chamber view and (B) cine SSFP three-chamber view, showing significant reduction in the size of the apical thrombus (red arrow). Postgadolinium inversion recovery sequences performed in four-chamber view (C,D) revealed no evidence of myocardial fibrosis.