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[Assessment of an intracardiac mural thrombus by contrast enhanced computed tomography]
Insights
Computed tomography (CT) effectively detects intracardiac mural thrombi, especially in the left ventricle, outperforming other methods in visualizing thrombus size and location. This study confirms CT
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Medical Diagnostics
Background:
- Intracardiac mural thrombi pose diagnostic challenges.
- Accurate detection is crucial for patient management and treatment.
- Comparison with existing imaging modalities is necessary.
Purpose of the Study:
- To evaluate the diagnostic utility of computed tomography (CT) for intracardiac mural thrombi.
- To compare CT's performance against two-dimensional echocardiography (2-DE) and left ventricular cineangiography (LVG).
Main Methods:
- Retrospective analysis of patients undergoing CT for suspected intracardiac thrombi.
- Comparison of CT findings with 2-DE, LVG, and operative results.
- Assessment of CT's ability to detect thrombi in various cardiac locations.
Main Results:
- CT identified left atrial thrombi in valvular disease, coronary heart disease, and cardiomyopathy.
- CT detected left ventricular thrombi in 21% of myocardial infarction cases, particularly with ventricular aneurysm.
- CT demonstrated superior visualization of thrombus size, location, and characteristics compared to 2-DE and LVG, especially in difficult-to-access areas.
Conclusions:
- Contrast-enhanced CT is a valuable tool for diagnosing intracardiac mural thrombi.
- CT offers advantages over 2-DE and LVG in depicting thrombus details.
- CT's accuracy supports its role in clinical decision-making for thrombus detection.
Abstract:
The usefulness of computed tomography (CT) in the diagnosis of an intracardiac mural thrombus was examined by comparing with two-dimensional echocardiography (2-DE), left ventricular cineangiography (LVG), and operative findings. The following results were obtained: 1) Left atrial thrombi: Among 43 cases of valvular disease with mitral stenosis, left atrial thrombi were noted in 10 cases (13 regions) by CT. Out of these 13 regions, 2-DE detected six regions (Fig. 2). Among 11 patients who underwent operation, thrombi were present in four (six regions). Of these six regions, thrombus was suspected in one region and another one was undetectable, but detected in the remaining four regions by CT and was in good accord with the operative findings (Table 1). Left atrial thrombi were detected in two of 138 cases of coronary heart disease, and in one of 26 cases of cardiomyopathy by CT. 2) Left ventricular thrombi: Left ventricular thrombi were detected in 26 of 122 cases of myocardial infarction (21%) by CT, and had a particularly high incidence in the cases having a ventricular aneurysm (Fig. 4). Of 81 cases in which 2-DE was performed, left ventricular thrombi were detected in 13 cases by both CT and 2-DE, and were not detected in 59 cases by both methods. In nine cases 2-DE diagnosis was not consistent with CT (Table 2). Of 76 cases in which left ventricular cineangiography was performed, left ventricular thrombi were detected in 12 cases by both CT and LVG, and were not detected in 58 cases by both methods. There were six cases of disaccord between 2-DE and CT (Table 2). In two of five cases of congestive cardiomyopathy, left ventricular thrombi were noted by CT. CT was able to detect thrombi in the left atrial appendage, the left atrial lateral wall (Fig. 6), and the regions near the left ventricular apex, which were difficult to be investigated by 2-DE (Fig. 8). CT was, in particular, superior in depicting the size, location and property of thrombi. In addition, CT was able to depict clearly a small thrombus in the left ventricular apex to the extent of, or better than, left ventriculography. Therefore, contrast enhanced CT is a useful diagnostic method for the detection of intracardiac mural thrombi.