In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

Image of the Month: Apical Aneurysm with Thrombus

Image presented by the Working Group on Myocardial and Pericardial Diseases

Presented byMichael Arad, Leviev Heart Center, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

CMR images of a 33 years old male with history of apical hypertrophic cardiomyopathy showing apical aneurysm formation (A) and mid-ventricular obstruction during systole (B). The images after delayed gadolinium enhancement (C, D) show extensive scarring and apical thrombus (star). A typical ECG (E) shows deep inverted T waves, and progressive decapitation of R waves in the precordial leads, in association with development of an intraventricular conduction defect.


  1. Gotlib J. WorldHealthOrganization-defined eosinophilic disorders: 2011 updateon diagnosis, riskstratification, and management. Am J Hematol. 2011 Aug. 86(8):677-88.
  2. Loeffler W. Endocarditis parietalisfibroplasticamitBlut-eosinophilie, eineigenartigesKrankheitshild. Schweiz Med Wochenschr;. 1936. 66:817-820
  3. Kim CH, Vlietstra RE, Edwards WD, Reeder GS, Gleich GJ. Steroid-responsive eosinophilic myocarditis: diagnosis by endomyocardial biopsy. The American journal of cardiology. 1984;53: 1472-3.
  4. Mocumbi AO, Falase AO. Recentadvances in theepidemiology, diagnosis and treatment of endomyocardial fibrosis in africa. Heart. 2013;99:1481-1487
  5. Chopra P, Narula J, Talwar KK, Kumar V, Bhatia ML. Histomorphologiccharacteristics of endomyocardial fibrosis: an endomyocardial biopsy study. Human pathology. 1990; 21:613-6.
  6. Seki A, Patel S, Ashraf S, Perens G, Fishbein MC. Primary endocardial fibroelastosis: anunderappreciated cause of cardiomyopathy in children. CardiovascPathol. 2013;22:345-50
  7. Hassan WM, Fawzi ME, Helaly SA, Hegazy H, Malik S. Pitfalls in diagnosis and clinical echocardiographic, and hemodynamic findings in endomyocardial fibrosis: a 25-year experience. Chest. 2005;128: 3985–92.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

Contact us

ESC Working Group on Myocardial & Pericardial Diseases

European Society of Cardiology

European Heart House
Les Templiers
2035 Route des Colles
CS 80179 Biot

06903, Sophia Antipolis, FR

Tel: +