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

Treatment

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

 
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