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Cardiac Thrombus
Suhny Abbara, MD, FACR, FSCCT; Prabhakar Rajiah, MBBS, MD, FRCR, FSCMR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Clot formation within cardiac chamber, typically from flow disturbance or akinetic or dyskinetic wall due to prior infarct/aneurysm or cardiomyopathy, abnormal endothelium may contribute

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        • Image-Guided Biopsy

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Protocol Advise

                                              Selected References

                                              1. Hoey ET et al: MRI assessment of cardiac tumours: part 2, spectrum of appearances of histologically malignant lesions and tumour mimics. Quant Imaging Med Surg. 4(6):489-97, 2014
                                              2. Pazos-López P et al: Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 7(9):896-905, 2014
                                              3. Hur J et al: Dual-enhancement cardiac computed tomography for assessing left atrial thrombus and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol. 10(7):1021-7, 2013
                                              4. Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
                                              5. Rathi VK et al: Contrast-enhanced CMR is equally effective as TEE in the evaluation of left atrial appendage thrombus in patients with atrial fibrillation undergoing pulmonary vein isolation procedure. Heart Rhythm. 10(7):1021-7, 2013
                                              6. Romero J et al: Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis. Circ Cardiovasc Imaging. 6(2):185-94, 2013
                                              7. Bittencourt MS et al: Left ventricular thrombus attenuation characterization in cardiac computed tomography angiography. J Cardiovasc Comput Tomogr. 6(2):121-6, 2012
                                              8. Hur J et al: Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis. Radiology. 263(3):688-95, 2012
                                              9. Weinsaft JW et al: LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. JACC Cardiovasc Imaging. 4(7):702-12, 2011
                                              10. Weinsaft JW et al: Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance prevalence and markers in patients with systolic dysfunction. J Am Coll Cardiol. 52(2):148-57, 2008
                                              11. Korosoglou G et al: Prompt resolution of an apical left ventricular thrombus in a patient with takotsubo cardiomyopathy. Int J Cardiol. 116(3):e88-91, 2007
                                              12. Morlese JF et al: Acute ventricular and aortic thrombosis post chemotherapy. Br J Radiol. 80(952):e75-7, 2007
                                              13. Mueller J et al: Cardiac CT angiography after coronary bypass surgery: prevalence of incidental findings. AJR Am J Roentgenol. 189(2):414-9, 2007
                                              14. Rustemli A et al: Evaluating cardiac sources of embolic stroke with MRI. Echocardiography. 24(3):301-8; discussion 308, 2007
                                              15. Fieno DS et al: Cardiovascular magnetic resonance of primary tumors of the heart: a review. J Cardiovasc Magn Reson. 8(6):839-53, 2006
                                              16. Peters PJ et al: The echocardiographic evaluation of intracardiac masses: a review. J Am Soc Echocardiogr. 19(2):230-40, 2006
                                              17. White RD: MR and CT assessment for ischemic cardiac disease. J Magn Reson Imaging. 19(6):659-75, 2004
                                              18. Mohiaddin RH et al: Valvular heart disease. In Manning WJ et al: Cardiovascular Magnetic Resonance. Philadelphia: Churchill Livingstone, 2002
                                              19. Antman EM et al: Acute myocardial infarction. In Braunwald E: Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: W. B. Saunders Company, 2001
                                              20. Dähnert WF: Radiology Review Manual. 4th ed. Philadelphia: Lippincott Williams & Wilkins. 316, 1999
                                              21. Dinarevic S et al: Left ventricular pannus causing inflow obstruction late after mitral valve replacement for endocardial fibroelastosis. Pediatr Cardiol. 17(4):257-9, 1996
                                              22. Characterization of cardiac masses with T1 mapping
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Clot formation within cardiac chamber, typically from flow disturbance or akinetic or dyskinetic wall due to prior infarct/aneurysm or cardiomyopathy, abnormal endothelium may contribute

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Echocardiographic Findings

                                                                • Angiographic Findings

                                                                  • Imaging Recommendations

                                                                    • Image-Guided Biopsy

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Protocol Advise

                                                                                          Selected References

                                                                                          1. Hoey ET et al: MRI assessment of cardiac tumours: part 2, spectrum of appearances of histologically malignant lesions and tumour mimics. Quant Imaging Med Surg. 4(6):489-97, 2014
                                                                                          2. Pazos-López P et al: Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 7(9):896-905, 2014
                                                                                          3. Hur J et al: Dual-enhancement cardiac computed tomography for assessing left atrial thrombus and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol. 10(7):1021-7, 2013
                                                                                          4. Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
                                                                                          5. Rathi VK et al: Contrast-enhanced CMR is equally effective as TEE in the evaluation of left atrial appendage thrombus in patients with atrial fibrillation undergoing pulmonary vein isolation procedure. Heart Rhythm. 10(7):1021-7, 2013
                                                                                          6. Romero J et al: Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis. Circ Cardiovasc Imaging. 6(2):185-94, 2013
                                                                                          7. Bittencourt MS et al: Left ventricular thrombus attenuation characterization in cardiac computed tomography angiography. J Cardiovasc Comput Tomogr. 6(2):121-6, 2012
                                                                                          8. Hur J et al: Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis. Radiology. 263(3):688-95, 2012
                                                                                          9. Weinsaft JW et al: LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. JACC Cardiovasc Imaging. 4(7):702-12, 2011
                                                                                          10. Weinsaft JW et al: Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance prevalence and markers in patients with systolic dysfunction. J Am Coll Cardiol. 52(2):148-57, 2008
                                                                                          11. Korosoglou G et al: Prompt resolution of an apical left ventricular thrombus in a patient with takotsubo cardiomyopathy. Int J Cardiol. 116(3):e88-91, 2007
                                                                                          12. Morlese JF et al: Acute ventricular and aortic thrombosis post chemotherapy. Br J Radiol. 80(952):e75-7, 2007
                                                                                          13. Mueller J et al: Cardiac CT angiography after coronary bypass surgery: prevalence of incidental findings. AJR Am J Roentgenol. 189(2):414-9, 2007
                                                                                          14. Rustemli A et al: Evaluating cardiac sources of embolic stroke with MRI. Echocardiography. 24(3):301-8; discussion 308, 2007
                                                                                          15. Fieno DS et al: Cardiovascular magnetic resonance of primary tumors of the heart: a review. J Cardiovasc Magn Reson. 8(6):839-53, 2006
                                                                                          16. Peters PJ et al: The echocardiographic evaluation of intracardiac masses: a review. J Am Soc Echocardiogr. 19(2):230-40, 2006
                                                                                          17. White RD: MR and CT assessment for ischemic cardiac disease. J Magn Reson Imaging. 19(6):659-75, 2004
                                                                                          18. Mohiaddin RH et al: Valvular heart disease. In Manning WJ et al: Cardiovascular Magnetic Resonance. Philadelphia: Churchill Livingstone, 2002
                                                                                          19. Antman EM et al: Acute myocardial infarction. In Braunwald E: Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: W. B. Saunders Company, 2001
                                                                                          20. Dähnert WF: Radiology Review Manual. 4th ed. Philadelphia: Lippincott Williams & Wilkins. 316, 1999
                                                                                          21. Dinarevic S et al: Left ventricular pannus causing inflow obstruction late after mitral valve replacement for endocardial fibroelastosis. Pediatr Cardiol. 17(4):257-9, 1996
                                                                                          22. Characterization of cardiac masses with T1 mapping