Description
A 36-year-old man with a malaria history was presented to our CCU department because of multiple serous effusion. Due to dyspnea, he had several hospitalizations before without improvement, then was presented to our hospital. Laboratory examination indicated that the effusion fluid was transudate. Physical examination showed systemic circulatory congestion with severe cyanosis. Echocardiography, CT and MRI all suggested that right atrium thrombus, apical and right ventricular hypertrophy. We thought that multiple serous effusion was caused by myocardial disease. Cleared thrombus and relieved outflow tract obstruction by operation, and used warfarin for anticoagulation after the operation. Follow-up after 3 months showed effusion disappeared, hypoxemia and eosinophils (EOS) level improved.
Key Finding(s)
Echocardiography: Huge right atrium with mural thrombus, right ventricular apical hypertrophy, right ventricular cavity was reduced and filled with thrombotic-like substances.
Contrast-enhanced echocardiography: Left ventricular apex showed well, right ventricular apical endometrial thickening and perfusion defect (thrombus?).
Cardiac MRI: Right ventricular apical hypertrophy (25.2mm); right atrial mural mass.
Differential Diagnosis
1.Heart failure 2.Constrictive pericarditis
3.Venous embolism
4.Cirrhosis or kidney disease
Implication(s)
It is a rare, complicated and critical case, the patient had several hospitalizations before the diagnosis was confirmed. Important experience to share in this case:
1. The first step in the diagnosis of a complex case is to find a breakthrough. In this case, the breakthrough is multiple serous effusion.
2. Echocardiography and contrast-enhanced echocardiography are of great value in the diagnosis of complex cardiomyopathy.
3. The advanced loffer's disease is characterized by endocardial thickening, thrombosis, and increased heart load. The treatment can be combined with surgery and anticoagulation, while hormones can be used to control the increase of EOS.

The truth behind multiple serous effusion: A case of advanced Loffer's disease

ECHO ASIA is organized by Asian-Pacific Association of Echocardiography (AAE). The meeting combines the basic echocardiography training curriculum and the state-of-the-art lectures/scientific sessions provided by international as well as Asian-Pacific experts. The meeting is a unique forum where scientists from many countries in the Asian-Pacific region who are involved in the field of Doppler echocardiography gather together to exchange knowledge and skills. Various internationally distinguished faculties consent to present their findings and reveal their clinical experiences in ECHO ASIA.