Multiple echo views in EMF

Parasternal long axis (PLAX) view being the first view taken in most echocardiographic studies, gives this image with dilated right ventricular outflow tract (RVOT). This pattern alone will not give a suspicion of endomyocardial fibrosis (EMF) as RVOT can be dilated along the with the rest of the right ventricle in conditions causing right ventricular volume overload like an atrial septal defect as well as in Ebstein’s anomaly of the tricuspid valve. Conditions with a dilated RVOT will have a characteristic clinical finding of RVOT pulsations, along the left sternal border, in the third intercostal space. Pulsation is not associated with a heave in conditions like Ebstein’s anomaly and right ventricular EMF, where the right ventricular pressures are not elevated. LA: Left atrium; Ao: Aorta; LV: Left ventricle.

This image from a modified apical four chamber view shows the characteristic fibrosis and obliteration of right ventricular apex in EMF along with a dilated right atrium (RA). RV: Right ventricle. Right ventricular cavity is not much dilated.

Another image from a modified apical four chamber view shows the characteristic dimple at right ventricular apex due to the fibrotic process along with a small encysted effusion nearby. The long standing exudate in the pericardial space has been organized into a clot like structure. Dilated right atrium and the fibrosis at RV apex are visible. As the prevalence of EMF is coming down drastically, such images are rarely seen in an echocardiographic laboratory.