CASE 5531 Published on 15.01.2007

Apical Thrombus

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Kelle S, Nagel E. German Heart Institute Berlin and cmr-academy 13353 Berlin, Germany

Patient

60 years, male

Clinical History
Patient 6 months after myocardial infarction
Imaging Findings
The patient presented to the outpatient department 6 months after anterior myocardial infarction with inadequate echocardiographic image quality. MR imaging consisted of wall motion at rest and late Gd enhancement 10 minutes after injection of 0.2 mmol Gd-DTPA-BOPTA using a 3 Tesla magnet (Figures 1-4). Wall motion showed a resting wall motion abnormality throughout the basal, equatorial and apical anterior and anteroseptal, as well as the apical anterolateral, inferoseptal, inferior and inferolateral segments. Late Gd enhancement showed transmural scar in the same segments. In addition, an apical thrombus was found.
Discussion
Late Gd enhancement (or “late enhancement”, “delayed enhancement”) is now regarded as the reference standard for the assessment of irreversible myocardial damage. Bright tissue represents mainly necrotic tissue with cell membrane disruption (in acute myocardial infarction) or replacement of large myocardial cells by small fibrotic cells (in chronic myocardial infarction or cardiomyopathies). Thrombi occur frequently in patients after myocardial infarction due to the hypo- or akinesia of the ventricular wall. The combination of wall thinning with a broadly attached thrombus may be missed by echocardiography as well as steady state free precession magnetic resonance imaging. Since most thrombi do not take up Gd-DTPA based contrast agents these structures present as hypointense tumors in the left ventricular blood pool usually adjacent to enhanced myocardium in the late Gd enhanced images.
Differential Diagnosis List
Chronic anterior myocardial infarction with apical left ventricular thrombus.
Final Diagnosis
Chronic anterior myocardial infarction with apical left ventricular thrombus.
Case information
URL: https://www.eurorad.org/case/5531
DOI: 10.1594/EURORAD/CASE.5531
ISSN: 1563-4086