A comparative evaluation of cross-sectional echocardiography and computed tomography in a detection of left ventricular thrombus

Left ventricular (LV) thrombi are rarely recognized during life, though they are not infrequently found at post-mortem examination of patients succumbed to valvular disease, acute myocardial infarction, and cardiomyopathy. We presented five cases in which LV thrombi were detected by cross-sectional echocardiography (CSE) and confirmed by computed tomography. The main purpose of this study was to compare the echocardiographic findings of the LV thrombi with the manifestations of the LV thrombi on the computed tomograms, with a hope to augment the clinical utility of CSE in a detection of the LV thrombi. CSE was recorded from the apical and four chamber views in addition to the conventional approach. A computed tomographic whole-body scanner which utilized a continuously rotating gantry and pulsed anode with x-ray radiation collimated to form a thin fan-shaped beam was used. A complete section scan was performed in 3 seconds. Sustained enhancement was obtained with a rapid intravenous infusion of 30% meglumine iothalamate. Most of the LV thrombi were found to have shaggy irregular borders and/or showed a mobile mass echo at the apex. Computed tomographic findings suggestive of LV thrombi appeared as a defects, which was apparently different in quality from the surrounding myocardium or valvular apparatus. These findings were quite consistent with those of CSE with respect to the number and the location of the LV thrombi. Consequently, it may be concluded that CSE is a useful adjanct in a detection of LV thrombi and an additional use of computed tomogram will certainly open up a promising way to a more secure diagnosis of LV thrombi. (author)