Demonstration of left ventricular thrombus by conventional echocardiography

Abstract

There have been a number of reports of left atrial thrombus detection by echocardiography (1-4). However, a search of the literature failed t o reveal any reports of left ventricular throm bus diagnosed by this technique. A case is presented in which a ventricular thrombus was suspected by echocardiogram and was confirmed a t pathological examination of the specimen. CASE REPORTA 47 year old white male with a five-year history of hypertension and a three-year history of angina pectoris suffered an extensive inferinr wall myocardial infarction in August 1974. This event was complicated by extension of the infarction and severe congestive heart failure. He was maintained on digitalis and diuretics hut continued to have symptoms of mild congestive heart failure on this regimen. In December 1974, he experienced an embolus t o his right leg which responded to* medical therapy. In January 1975, he had further myocardial infarction again complicated by severe congestive heart failure.The patient underwent cardiac catheterization and at that time he demonstrated a mean pulmonary artery pressure of 35 mmHg and a left ventricular end diastolic pressure of 28 mmHg. Coronary angiography revealed total occlusion of the right coronary artery and subtotal occlusion of the left anterior descending coronary artery distal to the origin of the diagonal branch. which itself demonstrated high grade proximal stenosis. The circumflex coronary artery was also totally occluded. A left ventriculograni demonstrated focal areas of left-ventricular freewall dyskinesia and an extensive area of dyskin- esia of the diaphragmatic surface. There was a poorly defined opacity at the apex of the left ventric,le compatible with but not diagnostic of a thromhis. The patient was not considered a suitable (.andidate for revascularization surgery and was r<.lprred t o this institution for cardiac transplantation.Lcshocardiographic examination was perEvrnird using a commercially available echoc m l h 4 ' Tnirad) and a 2.25 MHz, 7.5 cm focused t r a~d i i~ 'r (13 mm diameter). Continuous ~m ('*-4 was obtained by means of a Tektronix striii ' ?rt recorder (B 191416). An echocardioera111 ( Fig. 1) was obtained from the fourth iritercostal space at the left sternal edge. On sc~jnniiig the left ventricular cavity, the anterior a n d posterior mitral leaflets were observed to be normal. The left ventricular maximal end diastolic dimension was 5.6 cm and the posterior wall of the left ventricle was markedly hypocont,ractile. On scanning toward the apex of the left vwtricle, the interventricular septum was seen to hwome hypoactive and thinned and a large inass of echoes appeared, closely applied t o the hypoactive, thin portion of the interventricular wptiini within the left ventricular cavity.Subsequently a donor heart became available. 'The patient's heart was removed at operation and subjected to pathological examination. Careful examination of the specimen revealed multip1p patchy areas of fibrosis particularly marked in the posterior wall of the left ventric...

Diagnosis of left ventricular thrombi by two-dimensional echocardiography.

“…Early experience with M-mode echocardiography suggested that left ventricular thrombi were seldom recognised, though recent reports are more promising (Horgan et al, 1976). There are few series using two-dimensional echocardiography (Ports et al, 1978;DeMaria et al, 1979).…”