Left image (apical four chamber view on echocardiography) shows a fairly big thrombus in the right atrium. Right image (apical five chamber view on echocardiography) shows fibrosis at the right ventricular apex characteristic of endomyocardial fibrosis, a type of restrictive cardiomyopathy. RV: right ventricle; LV: left ventricle; RA: right atrium; LA: left atrium; mass pointed by the arrow is actually a right atrial thrombus, which disappeared on a repeat echocardiogram taken after anticoagulation. These thrombi can embolize into the pulmonary vascular tree and cause acute cor pulmonale or pulmonary infarction with hemoptysis.
Incidence of endomyocardial fibrosis is coming down and becoming very rare. Now florid cases are seldom seen. Most often forme fruste cases and few of the long term survivors of the older generation are seen.