Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2018; 6(6): 127-131
Published online Jun 16, 2018. doi: 10.12998/wjcc.v6.i6.127
Elusive left ventricular thrombus: Diagnostic role of cardiac magnetic resonance imaging-A case report and review of the literature
Irfan Siddiqui, Tin Nguyen, Assad Movahed, Deepa Kabirdas
Irfan Siddiqui, Tin Nguyen, Assad Movahed, Deepa Kabirdas, Department of Cardiovascular Sciences, East Carolina University, Brody School of Medicine, East Carolina Heart Institute, Greenville, NC 27858, United States
Author contributions: Siddiqui I, Nguyen T, Movahed A and Kabirdas D contributed to the manuscript writing and revision.
Informed consent statement: Patient was not required to give informed consent to the study because the analysis used anonymous data that were obtained after the patient agreed to treatment by written consent.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Assad Movahed, MD, Attending Doctor, Department of Cardiovascular Sciences, East Carolina University, Brody School of Medicine, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27858, United States. movaheda@ecu.edu
Telephone: +1-252-7444400 Fax: +1-252-7447724
Received: February 14, 2018
Peer-review started: February 14, 2018
First decision: March 8, 2018
Revised: March 24, 2018
Accepted: April 11, 2018
Article in press: April 12, 2018
Published online: June 16, 2018
Abstract

Identification of left ventricular mural thrombus (LVT) may be challenging depending on the imaging modality used. We present a case of LVT which was incidentally identified on cine cardiac magnetic resonance imaging (CMR). A sixty-four years old female presented with worsening dyspnea on exertion with troponin elevation. Transthoracic echocardiography (TTE) revealed a dilated left ventricle (LV) and ejection fraction (EF 30%) with thinning and akinesis of inferior/inferolateral wall was noted with basal and mid inferior wall aneurysm, and thrombus was not identified. CMR done to ascertain viability of myocardium revealed a mural thrombus within basal inferior aneurysm. This was not visualized on transthoracic echocardiography with and without use of contrast. She underwent coronary artery bypass grafting, bioprosthetic mitral valve replacement, resection and plication of posterior left ventricular aneurysm with removal of mural thrombus, and was started on anticoagulation with warfarin post-operatively for the apical thrombi. Cardiac magnetic resonance is a well suited imaging modality in detecting LVT due to its high resolution images and is more reproducible than TTE. In our patient, conventional TTE despite administration of echo-contrast agents failed to diagnose the presence of LVT in the basal inferior aneurysm as well as the apical thrombi. Delayed-enhancement CMR provides the greatest sensitivity for detection of left ventricular thrombus, superior to standard transthoracic and contrast-enhanced transthoracic echocardiography.

Keywords: Left ventricular thrombus, Cardiovascular magnetic resonance, Transthoracic echocardiogram

Core tip: Delayed-enhancement cardiac magnetic resonance imaging provides the greatest sensitivity for detection of left ventricular thrombus, superior to standard transthoracic and contrast-enhanced transthoracic echocardiography.