Endocardial fibroelastosis demonstrated on multidetector computed tomography

Abstract

A 26-year-old male worker from Vietnam presented to the outpatient clinic with progressive dyspnea. He had no history of smoking and alcohol drinking. His blood pressure was 110/ 70 mm Hg, and heart rate was 78/min. Chest X-ray showed cardiomegaly without calcification and ECG showed incomplete right bundle branch block. Complete blood count disclosed normal leukocyte counts without eosinophilia. Physical examination revealed both legs pitting edema, neck vein engorgement and hepatomegaly. Transthoracic echocardiogram showed dilated 4 chambers with moderate mitral and tricuspid valve regurgitation but preserved left ventricular systolic function. Mitral inflow pattern and mitral annulus velocity by tissue Doppler showed restrictive physiology. Echocardiography also revealed thrombus in right atrium (RA) and moderate pulmonary hypertension (estimated pulmonary systolic pressure was 46 mm Hg). But it showed no definite endocardial or myocardial abnormality. We performed ECGgated cardiac 16-slice multidetector computed tomography (MDCT) for the more precise endomyocardial and pericardial details. We could not perform arterial phase scan because of patient's intractable cough. So we performed somewhat delayed scan about 1 min after contrast injection. The images