Four-Chamber Cardiac Magnetic Resonance Imaging of Endomyocarditis With Ebstein Anomaly

A man in his 50s presented with progressive dyspnea, eosinophilia (3.27 × 109/L), thrombocytopenia (53 × 109/L), and elevated troponin T levels (530 ng/L). Cardiac magnetic resonance imaging revealed biventricular thrombus formation. Moreover, the criteria for Ebstein anomaly were formally met, with apical displacement of the tricuspid valve. The distance between the septal insertion point of the anterior mitral valve and the tricuspid valve was 0.81 mm/m2. Given the rarity of both diagnoses and the presence of one similar report in the literature, we suggest 2 potential etiologies: (1) tricuspid valve tethering as a result of ventricular shrinking due to inflammation and scarring and (2) potential genetic association between hypereosinophilia and Ebstein anomaly. The diagnosis of idiopathic eosinophilic syndrome with eosinophilic endomyocarditis was established after comprehensive diagnostic rule out of known etiologies of eosinophilia.
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