Intracardiac thrombus
Patients with a history of ischemic heart disease or myocardial infarction can frequently suffer complications from ventricular thrombi. Thrombi in the left ventricle serve as a common source of stroke or peripheral arterial embolic syndromes. Right ventricular thrombi may be a source of pulmonary emboli. Given the severity of these complications, accurate diagnosis of intracardiac thrombi is considered emergent.
Currently, transesophageal echocardiography (TEE) is the technique used to diagnose intracardiac thrombi. Our experience has shown, however, that contrast-enhanced Cardiac MR (magnetic resonance) is emerging as a complementary technique to detect and further characterize intracardiac thrombi. When performing myocardial viability studies, not only can the extent and impact of the ischemic event be evaluated, but also the frequent complications such as thrombus formation can be diagnosed.
Key Points
- The frequency of left ventricular (LV) thrombi is approximately 30 percent in patients with an acute or healed myocardial infarction. Most thrombi develop within the first week after infarction and are most often noted in the apex of the left ventricle in patients with an anterior wall infarct.
- Risk factors for development of LV thrombus include infarct location, the size and extent of infarction, and impaired global or regional wall motion.
- Contrast-enhanced Cardiac MR complements transesophageal echo in detecting thrombi which are hard to visualize on TEE, including small thrombi (less than one cubic centimeter) and large apical thrombi.
Case in Point
76 year old male status post myocardial infarction (MI). Four-chamber view demonstrates an intracardiac thrombus adjacent to the area of infarct at the apex.
For Further Reading
- Barkhausen J, Hunold P, Eggebrecht H, Schuler WO, Sabin GV, Erbel R, Debatin JF. Detection and characterization of intracardiac thrombi on MR imaging. AJR Am J Roentgenol. 2002 Dec;179(6):1539-44.
- Mollet NR, Dymarkowski S, Volders W, Wathiong J, Herbots L, Rademakers FE, Bogaert J. Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease. Circulation. 2002 Dec 3;106(23):2873-6.