Images in Cardiovascular Medicine

A 27-year-old man who was known to have hypereosinophilic syndrome (HES) underwent evaluation at our echocardiography laboratory for exertional dys-pnea. Laboratory tests revealed leukocytosis (5.4 109/L) with marked eo-sinophilia (34.6%; normal range, 4%), in addition to an elevated level of tryptase (70 ng/mL; normal range, 13.5 ng/mL). Two-dimensional transthoracic echocar-diography showed an echodense structure that obliterated the left ventricular apex, consistent with thrombus and thickening of the posterobasal wall (Figs. 1 and 2). Pulsed-wave and tissue Doppler echocardiography revealed a left ventricular restric-tive filling pattern (Figs. 3 and 4). Comment Hypereosinophilic syndrome is a rare multisystemic disease with a grave progno-sis. Cardiac involvement is present in 40 % of cases.1 Chusid and colleagues2 defined idiopathic HES as an unexplained eosinophil count greater than 1,500 cells/mL, persisting longer than 6 months, and resulting in single- or multiple-organ system dysfunction attributable to cytotoxic injury by eosinophils. Cardiac involvement is the most disastrous complication of this clinical situation.3 The overall mortality rat