Pediatric acute heart failure caused by endocardial fibroelastosis mimicking dilated cardiomyopathy: A case report

Figure 1 Chest radiograph, color doppler echocardiography, and cardiac magnetic resonance of the child. A: Prominently enlarged heart with a high cardiothoracic ratio; B: Marked enlargement of the left ventricle (inner diameter 38.70 mm) with diffuse slight thickening of the endocardium; C: Thickening of the posterior wall of the left ventricle (purple arrow); D: A small amount of mitral regurgitation (yellow arrow); E: Bright-blood T₁-weighted image shows slight endocardial thickening of the left ventricle and slight thickening of the myocardium (orange arrow); F: Dark-blood T₂-weighted image shows diffuse ventricular wall hypokinesis without visible delayed enhancement abnormalities (orange arrow).

Figure 2 Abdominal color ultrasonography and endomyocardial biopsy for the child. A and B: Congestive hepatomegaly with a right oblique diameter of 8.25 cm and an inferior hepatic border 6.32 cm from the right inferior costal arch border of the midclavicular line; C and D: Endomyocardial biopsy shows diffuse elastin and collagen hyperplasia (black arrow).

Figure 3 Chest X-ray and thoracic and abdominal computed tomography re-examination results of the child before discharge. A and B: Mild cardiac retraction; C: Remarkable retraction of the previously enlarged liver.

Figure 4 Timeline of the child’s visit, hospitalization, and postdischarge follow-up. CDE: Color doppler echocardiography; CO₂CP: Carbon dioxide combining power; CRP: C-reactive protein; DCM: Dilated cardiomyopathy; HGB: Hemoglobin; i.m.: Intramuscular; i.v.: Intravenous; EFE: Endocardial fibroelastosis.