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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Left ventricular apical and atrial appendage thrombus with hypertrophic cardiomyopathy in sinus rhythm: a case report
Manabu Izumi1, Tomohiko Iwata2, Masaru Ichida2
1Department of Cardiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. izumi@jichi.ac.jp.
Insights
This study highlights a case of cardiac masses in a patient with hypertension and diabetes, ultimately diagnosed as thrombi. Prompt surgical intervention was crucial for managing congestive heart failure and stroke symptoms.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiomyopathy
Background:
- A 47-year-old female presented with a left ventricular mass, congestive heart failure, and a history of untreated hypertension and diabetes mellitus.
- The patient experienced a cardio-embolic stroke, complicating the differential diagnosis between cardiac thrombus and tumor.
Purpose of the Study:
- To investigate the nature of cardiac masses in a patient with complex cardiovascular risk factors.
- To evaluate the efficacy of cardiac CT in mass characterization and surgical planning.
Main Methods:
- Echocardiography revealed a left ventricular mass.
- Cardiac computed tomography (CT) was utilized for detailed imaging of cardiac masses and coronary arteries.
- Surgical resection of identified masses and affected myocardium was performed.
Main Results:
- Cardiac CT identified masses in the left ventricle and left atrial appendage, highly suggestive of thrombi.
- Pathological examination confirmed both masses as thrombi.
- Myocardial disarray was consistent with hypertrophic cardiomyopathy.
Conclusions:
- Cardiac masses in this patient were diagnosed as thrombi, necessitating urgent surgical intervention.
- The case underscores the importance of advanced imaging in differentiating cardiac masses.
- Hypertrophic cardiomyopathy was confirmed as an underlying condition.
Abstract:
A 47-year-old female with a history of untreated hypertension and diabetes mellitus was referred because of a left ventricular echocardiographic mass with congestive heart failure. At the time of admission, she had already had a cardio-embolic stroke with loss of recent memory and slight paralysis of the right upper arm. It was difficult to distinguish between thrombus and tumor. However, her clinical condition required surgical resection as soon as possible. We performed cardiac CT to evaluate the coronary arteries and to scan the mass at the left ventricular apex. This CT evaluation revealed another mass at the left atrial appendage. Thus, these two masses were highly suggestive of thrombi. Subemergency surgical resection of the two masses and a part of the myocardium at the left ventricular apex was successfully performed. The pathological results showed that both the mass in the left ventricular apex and the mass in the left atrial appendage were thrombi, and the myocardial disarray confirmed the echocardiographic diagnosis as hypertrophic cardiomyopathy.
