Siddiqui I, Nguyen T, Movahed A, Kabirdas D. Elusive left ventricular thrombus: Diagnostic role of cardiac magnetic resonance imaging-A case report and review of the literature. World J Clin Cases 2018; 6(6): 127-131 [PMID: 29988880 DOI: 10.12998/wjcc.v6.i6.127]
Corresponding Author of This Article
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
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
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
ARTICLE HIGHLIGHTS
Case characteristics
A 64-year-old female with type II diabetes and hypertension presented with worsening dyspnea on exertion that had rapidly progressed from her baseline with orthopnea and paroxysmal nocturnal dyspnea.
Clinical diagnosis
Pulmonary rales, jugular venous distension, and a loud holosystolic murmur radiating to axilla.
Differential diagnosis
New-onset heart failure due to mitral regurgitation vs cardiomyopathy.
Laboratory diagnosis
Elevated troponin and brain natriuretic peptide.
Imaging diagnosis
Transthoracic echocardiogram with ultrasound enhancing agent showed severe functional secondary mitral regurgitation and reduced left ventricle ejection fraction of 30% with inferior wall aneurysm, while delayed enhancement cardiac magnetic resonance imaging (CMR) illustrated a large mural thrombus measuring 3.0 cm x 1.3 cm adherence to the basal inferior wall aneurysm as well as two apical thrombi.
Treatment
Coronary artery bypass grafting, mitral valve replacement, removal of mural thrombus, and resection and plication of ventricular aneurysm.
Related reports
Cardiac magnetic resonance is a well suited imaging modality in detecting left ventricular thrombus due to its high resolution images and is more reproducible than transthoracic echocardiogram.
Experiences and lessons
Delayed-enhancement CMR provides the greatest sensitivity for detection of left ventricular thrombus, superior to standard transthoracic and contrast-enhanced transthoracic echocardiography.
