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Diagnostic Dilemma in Left Ventricular Noncompaction Cardiomyopathy: Thrombus or Tumor?
Mohamed O Elhussain1, Mazen Ahmed2, Ragda Ali3
1Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA.
Insights
Left ventricular noncompaction cardiomyopathy (LVNC) can mimic tumors. This case shows a resolved apical mass, initially concerning for cancer, was actually a resolved thrombus in LVNC, highlighting the need for serial imaging.
Area of Science:
- Cardiology
- Medical Imaging
- Pathology
Background:
- Left ventricular noncompaction cardiomyopathy (LVNC) presents diagnostic challenges, particularly with intracardiac masses.
- Thromboembolic complications are a known risk in LVNC patients.
- Distinguishing intracardiac masses from thrombi requires careful evaluation.
Abstract:
Left ventricular noncompaction cardiomyopathy (LVNC) is associated with thromboembolic complications and can complicate intracardiac mass interpretation. A 58-year-old man with prior left ventricular (LV) apical thrombus presented with abdominal pain and weight loss. Contrast-enhanced transthoracic echocardiogram (TTE) showed severe LV dysfunction (left ventricular ejection fraction (LVEF) 15-20%) and a 1.5 cm mobile apical mass with apparent central contrast uptake, raising concern for a tumor in the setting of suspected prostate malignancy. Heparin was initiated. On day 3, the mass had resolved, and repeat echocardiography demonstrated prominent apical trabeculations and a low-flow apex with findings suggestive of LVNC, indicating that the perceived "vascularity" likely reflected pseudo-enhancement. This case emphasizes serial imaging and multimodality assessment when uncertainty persists.
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