[Giant left ventricular thrombi in the hypereosinophilic syndrome: report of two cases].

This is a report of two cases of the hypereosinophilic syndrome with an unusual apical filling defect suggestive of an intraventricular mass. Case 1 (45-year-old man): This patient had marked eosinophilia, congestive heart failure, and murmurs of aortic and mitral regurgitation. A subcutaneous cervical mass revealed histologic features of angiolymphoid hyperplasia with eosinophilia (so-called Kimura's disease). Left ventriculography confirmed mitral regurgitation with extensive obliteration of the left ventricular cavity. It was suspected that an extensive ventricular mural thrombus was superimposed on a thickened endocardium. Right ventricular endomyocardial biopsy showed focal regions of fibrosis in the myocardium, and infiltration of eosinophils were identified. Case 2 (70-year-old man): This patient had marked eosinophilia and congestive heart failure. Left and right angiography showed apical filling defects suggestive of intraventricular mass. Right ventricular endomyocardial biopsy showed focal areas of fibrosis, and infiltration of eosinophils were observed. Diagnosis of Löffler's endocarditis was made. It is suggested that the spectrum of ventricular abnormalities in these patients results from endomyocardial fibrosis of varying severity, and that eosinophilia may play a leading role or may associate with the genesis of the disease in these two cases.