Imaging Sciences Interesting Cases
Case 290
Mary Fontanella, MD
Clinical Presentation: Patient is a 54-year-old female with history of breast and thyroid cancer presenting for metastatic work-up.
Imaging Findings: Left ventricular thrombus.
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Figure 1: Axial CT image through the left ventricle demonstrates marked cardiomegaly and mural thrombus in the left ventricle extending from the septum to the posterior wall and involving the apex. |
Diagnosis: Left ventricular thrombus
Discussion: Left ventricular thrombus is seen in the setting of reduced wall motion and is associated with myocardial infarction (MI), cardiomyopathy, and ventricular aneurysm. It is commonly associated with anterior MI, where it occurs in 30-40% of cases, compared to <5% in inferior MI. Fifty-five to 85% of thrombi resolve within 3 years untreated, but the presence of thrombus increases risk for thromboembolic event, and observational studies suggest some benefit in prevention of thromboembolism with warfarin treatment.
References:
- Kontny F, Dale J. Left ventricular thrombus formation and resolution in acute myocardial infarction. Int J Cardiol. 1998 Sep 30;66(2):169-74. PMID: 9829331 [PubMed]