Diverse Radiologic Presentations of Common Pathology: Role of Cardiac Magnetic Resonance in the Workup of Intracardiac Thrombi and Mimics- A Pictorial Review

Abstract

Thrombus represents the most common cardiac mass compared to primary or secondary cardiac tumors. It has variable size, shape, location, and imaging features. Differentiating the cardiac mass as a tumor, thrombus, or vegetation is clinically important due to their different therapeutic implications and prognostic outcomes. Thrombi carry an inherent risk of systemic and pulmonary embolism and warrant appropriate anticoagulation. For over two decades, echocardiography (transthoracic as well as transesophageal) has been the gold standard investigation to detect intracardiac thrombi. However, recent advances in cardiac magnetic resonance imaging allow higher sensitivity and specificity in the detection of thrombi and the assessment of the age of the thrombi by characterization of their contents. The objective of this review is to demonstrate different imaging presentations of cardiac thrombi and how imaging can help differentiate it from other mimics.