A black mobile mass: diagnosis and management

Area of Science:

• Cardiology
• Cardiovascular Imaging

Background:

• Left ventricular apical thrombi (LVAT) post-myocardial infarction (MI) pose diagnostic and therapeutic challenges.
• Established treatment guidelines for LVAT are lacking, with options including fibrinolysis, anticoagulation, and surgery.

Observation:

• A 37-year-old male presented with pleuritic chest pain and ECG findings of anterior wall MI.
• Transthoracic echocardiography revealed a large, mobile LV apical thrombus.
• Contrast echocardiography and cardiac MRI with late gadolinium enhancement confirmed the diagnosis and excluded pseudoaneurysm.

Findings:

• The patient was treated with intravenous heparin followed by oral anticoagulation.
• Follow-up echocardiography at two months demonstrated a smaller, non-mobile apical thrombus.

Implications:

• This case highlights the utility of advanced imaging modalities in diagnosing LV apical thrombi.
• Anticoagulation appears to be an effective treatment strategy for reducing LV apical thrombi post-MI.
• Further research is warranted to establish definitive treatment protocols for LVAT.