ABC | Volume 112, Nº6, June 2019

Anatomopathological Correlation Arq Bras Cardiol. 2019; 112(6):793-802 Issa and Benvenuti Pulmonary infiltrate and left ventricular apex obliteration in a young man Figure 11 – Left ventricular cardiomyocyte disarray. Hematoxylin-eosin, X100. Figure 12 – Histological constitution of the affected endocardium, compatible with endomyocardial fibrosis. There is luminal thrombosis (arrow), superficial area of dense fibrosis (asterisk) and underlying area of loose fibrosis with neoformed vessels and foci of discrete inflammatory infiltrate (double asterisk). Hematoxylin-eosin, X 25 Comments This is an interesting case of a 25-year-oldmale patient with a history of hypothyroidismafter treatment with radioactive iodine at an unspecified date, who developed congestive heart failure and died after a year of clinical follow-up. Imaging tests disclosed significant hypertrophy of the left ventricular mid‑apical region, with obliteration of the tip of the cavity, and the hypotheses of hypertrophic cardiomyopathy and endocardial fibrosis were suggested. The presence of suggestive signs of pulmonary hemorrhage and hematuria raised the suspicion of Goodpasture syndrome, but the complementary exams were not suggestive of this entity. The necropsy showed it was a case of cardiomyopathy of unusual pattern, characterized by the superposition of findings of hypertrophic cardiomyopathy and endomyocardial fibrosis. On the other hand, the findings were not typical of any of these diseases alone. Although there was marked left ventricular wall concentric hypertrophy, with apical and mid-mural predominance related to the hypertrophic cardiomyopathy, the areas of cardiomyocyte disarray, which constitute the most significant finding of the disease, did not occur in extensive areas, as usual. 15 Regarding the endomyocardial fibrosis, there was fibrous obliteration of the left ventricular apex, the typical histopathological constitution of the affected endocardium, and 801