Learning Radiology xray montage

Left Ventricular Thrombus


General Considerations

  • Frequent complication of acute myocardial infarction (AMI) and dilated cardiomyopathy
    • Most often seen in those with large anterior infarcts with ST-elevation (STEMI) apicoanterior aneurysm formation
  • Significance lies in its ability to arterially embolize
  • Contributing factors include
    • Regional-wall akinesia or dyskinesia
    • Endocardial inflammation providing a thrombogenic surface
    • Hypercoagulable state

Clinical Findings

  • Most frequent clinical presentation is the occurrence of a stroke after AMI, usually within the first 10 days

Imaging Findings

  • Transthoracic echocardiography is the imaging modality of first choice
  • CT’s  specificity and sensitivity in detecting LV mural thrombus are similar to 2-D transthoracic echocardiography
  • CT can detect new or organized thrombi as small as 2-3 cm in diameter
  • Requires intravenous contrast administration
  • Diagnosis is aided by the lack of enhancement of thrombi versus cardiac tumors
  • Delayed enhancement cardiac MRI is very useful in identifying left ventricular aneurysms
  • Gadolinium may be used to help differentiate myocardium from thrombus
  • The avascular LVT is viewed as an absence of contrast uptake adjacent to hyper-enhanced, scarred myocardium

Differential Diagnosis

  • Myxoma – usually occurs on the interatrial septum and projects into left atrium


  • Anticoagulant therapy may substantially decrease the rate of embolic events by 33% compared with no anticoagulation 

 Left Ventricular Thrombus


Left Ventricular Thrombus, CT. Two, reformatted, gated-CT images of the heart show a filling defect (red arrow) in the apex of the left ventricle (LV). LA=left atrium, RA=right atrium, Ao=aorta.

Left ventricular thrombus. Peter J. Stokman, Charn S. Nandra, Richard W. Asinger. Current Treatment Options in Cardiovascular Medicine. December 2001, Volume 3, Issue 6, pp 515-521