Right ventricular thrombus, a challenge in imaging diagnostics: a case series

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Right ventricular thrombus (RVT) is a rare, life-threatening condition requiring prompt diagnosis and treatment.
• Distinguishing RVT from other intraventricular masses is challenging with standard imaging.
• Current therapeutic strategies often overlook thrombus morphology, relying primarily on clinical presentation.

Observation:

• A case series reports three patients with RVT and pulmonary embolism (PE).
• Two of these RVT cases were initially missed by transthoracic echocardiography and computed tomography.
• Cardiac magnetic resonance imaging (CMR) successfully detected and characterized the RVT in these missed cases.

Findings:

• CMR demonstrates high sensitivity and specificity for detecting and characterizing RVT.
• CMR is effective even in challenging echocardiographic scenarios like arrhythmias or obesity.
• CMR provides crucial morphological information for differential diagnosis and therapeutic planning.

Implications:

• CMR facilitates informed therapeutic decisions, including anticoagulation, systemic lysis, or surgical thrombectomy.
• Future risk stratification scores may optimize the cost-effective utilization of CMR for RVT diagnosis.
• Integrating CMR into the diagnostic pathway can improve outcomes for patients with suspected RVT and PE.