A man in his mid-60s with a history of hypereosinophilia presented with heart failure symptoms and leukocytosis (white blood cell count, 39 800/μL; 44% eosinophils). Echocardiography showed normal left ventricular fraction, no wall motion abnormalities, and an echogenic band traversing the apical portion of the left ventricle. Cardiac magnetic resonance imaging revealed subendocardial fibrosis and transmural thrombus consistent with eosinophilic myocarditis and Löffler syndrome. Löffler syndrome is eosinophilic endocarditis leading to endomyocardial fibrosis causing restrictive cardiomyopathy and heart failure. Damaged endocardium and a prothrombotic milieu provide a nidus for mural thrombus formation. In this video, the thrombus manifests as the echogenic band. For full case details and more images, click the article link.
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