Intraventricular thrombi with systemic embolization: two clinical cases

Ventricular thrombi are a frequent complication of dilated cardiomyopathy and acute myocardial infarction, with variable risk of embolization according to the clinical setting and thrombus morphology. The authors report two cases of patients admitted on the same day for acute myocardial infarction and dilated cardiomyopathy respectively, with high embolic risk left ventricular thrombi that embolized to the lower limbs after admission. Echocardiography, considered the gold standard diagnostic tool for intraventricular thrombi, is also the mainstay of embolic risk evaluation, for characterizing their size, mobility and echostructure. In the absence of evidence-based guidelines, management options--anticoagulation therapy, thrombolysis or thrombectomy--must be decided according to each specific case, taking account of embolic, bleeding and surgical risk.