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Number 07-22 LV Thrombus

Case from: Lalith S.B. Jesuthasan, Andrew G.F. Elkington, John F. Beltrame.
The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia

History: A 59 year old man with previous anterior MI presented with a 6 hour history of acute dyspnoea without chest pain

Exam: pulmonary congestion

Echo: dilated LV, apical aneurysm and thrombus.

CMR Cine: identical to the echo (see comparison)

CMR contrast: Neatly confirms the sessile avascular contrast (arrow, dark) overlying transmural infarction (bright)

Discussion: Contrast-enhanced CMR is more sensitive and specific than echo in the detection of LV thrombus and should be considered the gold standard imaging modality for this pathology. Here, the diagnosis was never in doubt however.

References:
Srichai MB et al. Clinical, imaging and pathological characteristics of LV thrombus: A comparison of contrast-enhanced MRI, TTE and TOE with surgical or pathological validation: AHJ 2006;152:75-84.
Mollet NR et al. Visualization of ventricular thrombi with contrast enhanced MRI in patients with ischaemic heart disease: Circulation 2002;106:2873-76. Full text

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