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Differential diagnosis of left ventricular mural thrombi by myocardial contrast echocardiography: a preliminary study
T Asanuma1, K Tanabe, H Yoshitomi
1Fourth Department of Internal Medicine, Shimane Medical University, Izumo, Japan.
Insights
Myocardial contrast echocardiography (MCE) helps differentiate left ventricular mural thrombi from heart muscle. This technique visualizes blood flow, identifying thrombi as defects and myocardium as opacified areas.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Two-dimensional echocardiography is standard for diagnosing left ventricular mural thrombi.
- Distinguishing small or flat thrombi from myocardium can be challenging with conventional echocardiography.
Observation:
- Myocardial contrast echocardiography (MCE) visualizes myocardial blood flow distribution.
- The authors hypothesized that MCE could differentiate thrombi from myocardium due to thrombi's lack of arterial supply.
Findings:
- In two cases, MCE visualized an apical mural thrombus as a contrast defect, distinguishing it from myocardium.
- Conversely, myocardium mimicking a thrombus was clearly opacified by MCE.
Implications:
- MCE can reliably differentiate mural thrombi from myocardium.
- This technique is valuable for assessing thrombi after reperfusion therapy.
Abstract:
Two-dimensional echocardiography has become the procedure of choice to diagnose left ventricular mural thrombi. However, small or flat thrombi may be difficult to distinguish from myocardium. The spatial distribution of the ventricular myocardial blood flow can be imaged with myocardial contrast echocardiography (MCE). The authors presumed that the absence of arterial supply to a fresh thrombus may allow MCE to distinguish between thrombus and myocardium. In the 2 cases presented here, MCE was performed with the same technique as that used for the purpose of visualization of myocardial perfusion; as a result, an apical mural thrombus, indistinct from myocardium before MCE, was visualized as a contrast defect during imaging. Conversely, myocardium that mimicked a thrombus was imaged by MCE as a contrast-opacified area. These findings suggest that MCE after reperfusion therapy is useful to distinguish mural thrombi from myocardium.