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Ventricular mural thrombi - An occult occurrence?
1Department of Pathology (Cardiovascular and Thoracic Division), Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India.
Insights
Ventricular mural thrombi, often linked to heart attacks, can also occur without heart disease. Many cases are detected microscopically, highlighting the need to consider them in thromboembolism evaluations.
Area of Science:
- Cardiology
- Pathology
- Internal Medicine
Background:
- Ventricular mural thrombi are uncommon but significant mechanical complications of myocardial infarction.
- These thrombi can also arise in non-ischemic heart conditions or in individuals without cardiac disease.
- Clinical detection of ventricular mural thrombi is often challenging and size-dependent.
Purpose of the Study:
- To investigate the etiopathogenesis of ventricular mural thrombi.
- To establish a clinicopathologic correlation for these thrombi.
- To categorize thrombi based on underlying causes.
Main Methods:
- A 12-year retrospective observational autopsy study.
- Analysis of 93 cases with ventricular mural thrombi.
- Categorization into ischemic, non-ischemic myocardial, and non-myocardial groups.
Main Results:
- Ischemic heart disease was the most frequent cause (46.2%).
- Non-ischemic and non-myocardial causes accounted for 53.8% of cases.
- Microscopic detection was common, especially in non-ischemic groups with biventricular involvement.
Conclusions:
- Ventricular thrombi can occur in diverse clinical settings, including absence of cardiac disorders.
- Systemic or pulmonary thromboembolism warrants investigation for ventricular thrombi.
- Rethinking diagnostic approaches for ventricular mural thrombi is crucial.
Background:
Ventricular mural thrombi are rare occurrences and form one of the common mechanical complications of myocardial infarctions. They also occur in patients with nonischemic myocardial disorders and even in those devoid of cardiac diseases. Clinical detection often depends on the size of the thrombi.
Aim:
This study was aimed at ascertaining the etiopathogenesis of mural thrombi with a clinicopathologic correlation.
Materials And Methods:
This was a 12-year retrospective observational study reviewing the autopsy records of all cases showing ventricular mural thrombi. The location, size, morphology, and histologic appearances of the thrombi were noted. The cases, depending on the etiology, were categorized into myocardial ischemic (Group 1), myocardial nonischemic (Group 2), and non-myocardial (Group 3) causes. These features were correlated with the clinical settings.
Results:
There were 93 cases of mural thrombi with an almost equal sex distribution and a mean age of 45.9 years. The cause was ischemic heart disease in most of the patients (Group 1, 46.2%), while 21.5% and 32.3% of patients belonged to Group 2 and Group 3, respectively. Unlike the large and dominantly left ventricular thrombi seen in Group 1, the other two groups frequently had biventricular involvement, location in the intertrabecular spaces, and a high microscopic detection. Clinical diagnosis had been made in only 3.2% of patients. Thromboembolism was noted in other organs in 34.4% of the total cases.
Conclusion:
Ventricular thrombi should be ruled out in patients with evidence of systemic and/or pulmonary thromboembolism, even in those without any cardiac disorders.
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