Right ventricular mural thrombus caused by myocardial infarction diagnosed by computed tomography

Thrombi of the left ventricle are common sequelae to acute anterior myocardial infarctions that involve the apex of the heart and produce akinetic or dyskinetic wall thickening patterns. While infarctions of the right ventricle are being increasingly recognized in the setting of inferior myocardial infarcts, little data on in vivo clot formation in the right ventricle of the heart are available in these patients. In the current study we were able to demonstrate a right ventricular mural thrombus using gated computed tomography of the heart. Although an abnormality in the right ventricle extending from the septal margin of the ventricle into the outflow tract could be identified with standard blood pool computed tomographic images and from cross sectional echocardiograms, only with cardiac gating could the relationship between the mass (thrombus) and the noncontractile section of the right ventricular myocardium be clearly identified. We conclude that cardiac gating may help in the evaluation of cardiac masses, and in particular cardiac thrombi. This will be particular valuable in the setting of recent or remote infarction, as the relationship between wall-motion abnormalities and thrombus formation has been well documented.