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The square left ventricle: an angiographic and radionuclide sign of left ventricular thrombus
Insights
Left ventricular aneurysm is often associated with mural thrombus, which can be hard to detect. A squared apex on ventriculograms, seen in 5 patients, uniquely indicates left ventricular thrombus.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Left ventricular aneurysm is frequently associated with mural thrombus.
- Diagnosing left ventricular thrombus via traditional angiography presents challenges.
Purpose of the Study:
- To describe a unique imaging finding in patients with left ventricular thrombus.
- To correlate this finding with operative or autopsy confirmation.
Main Methods:
- Retrospective analysis of 5 patients with suspected left ventricular thrombus.
- Ventriculography in the right anterior oblique position.
- Radionuclide angiocardiography in select cases.
Main Results:
- A squared apex of the left ventricular cavity was observed in all 5 patients on ventriculograms.
- This finding was corroborated by radionuclide angiocardiography in 2 patients.
- All 5 patients were confirmed to have left ventricular thrombus.
Conclusions:
- A squared apex on right anterior oblique ventriculography is a unique indicator of left ventricular thrombus.
- This sign aids in the diagnosis of left ventricular thrombus, especially when conventional methods are difficult.
Abstract:
The association of mural thrombus with left ventricular aneurysm is well documented, though angiographic documentation of left ventricular thrombus can be difficult. The authors describe the unique appearance of the left ventricular cavity in 5 patients. In all cases, ventriculograms obtained in the right anterior oblique position showed a squared apex. In 2 patients this phenomenon was also demonstrated by radionuclide angiocardiography. All 5 patients were found to have left ventricular thrombus at operation or autopsy.