Case report: Use of unenhanced cardiac MR to evaluate low flow states for thrombus

Left atrial spontaneous echo contrast is an echocardiographic finding associated with hypercoagulable states and stasis and can be clinically correlated with a thromboembolism in patients with atrial fibrillation, mitral stenosis, or mitral valve repair. Black blood double inversion recovery cardiac magnetic resonance is used to map out cardiac anatomy and demonstrates higher signal in blood flowing at a slower rate, such as at the sites of aortic aneurysms, aortic dissections and vessel occlusions. Here, we present the case of a 66-year-old woman with persistent atrial fibrillation and left atrial findings of spontaneous echo contrast and high signal on black blood double inversion recovery cardiac magnetic resonance imaging, raising concern for a thrombus. However, this was ruled out with subsequent bright blood cardiac magnetic resonance imaging demonstrating high signal with transitory central swirling low signal in the left atrium. Thus, cardiac magnetic resonance imaging can be used to demonstrate non-thrombotic low flow states in cases where contrast is contraindicated.