Cover Image: Large ventricular thrombus misdiagnosed by ventriculography
Francisco Ridocci1, Jordi Estornell2, Francisco Pomar1, and Jose A. Velasco1
1Cardiology Department and 2CT and MRI Unit, Consorcio Hospital General Universitario de Valencia, Spain
A 68-year-old man with history of anterior myocardial infarction in February 2002 was referred to our institution because of congestive heart failure and a transthoracic echocardiographic study showing severe left ventricular (LV) dysfunction (ejection fraction 35%) with enlarged LV volumes and apical aneurysm with intracavitary laminar thrombus. Cardiac catheterization revealed a significant stenosis in the proximal segment of the left anterior descending coronary artery whereas ventriculography showed antero-lateral akinesia but normal volumes and LV ejection fraction (Panels 1A and B). Because of a mismatch between the echocardiography and ventriculography findings, magnetic resonance imaging (MRI) was performed. Delayed contrast-enhanced MRI with Gd-DTPA allowed us to identify the exact delimination of the scar (S) as well as the extent of a very large organized thrombus (T) that was not identified with ventriculography (Panels 2A and B), and had initially led us to overestimate the global LV function.
Figure legend:
Panel 1: (A) Left ventriculography end-diastolic view. (B) Left ventriculography end-systolic view.
Panel 2: (A) Delayed contrast-enhanced MRI two-chamber view. (B) Delayed contrast-enhanced MRI short-axis view.
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