Mural Thrombi of the Left Ventricle

Abstract

The diagnosis of left ventricular thrombus is of potential clinical importance in identifying patients at risk for systemic embolization. Over the past years, several sophisticated methods capable of detecting thrombus have been developed. Left ventricular thrombus can be detected by external imaging of radiolabeled blood components which are incorporated into thrombi, as with indium-III platelet imaging, 1 Stratton JR, Ritchie JL Hamilton GW Hammermeister KE Harker LA Left ventricular thrombi: in vivo detection by indium-IH platelet imaging and two dimensional echocardiography. Am J Cardiol. 1981; : 874-881 Abstract Full Text PDF PubMed Scopus (69) Google Scholar 2 Ezekowitz MD Wilson DA Smith EO et al. Comparison of indium-III platelet scintigraphy and two-dimensional echocardiography in the diagnosis of left ventricular thrombi. N Engl J Med. 1982; 306: 1509-1513 Crossref PubMed Scopus (114) Google Scholar or by the definition of anatomic filling defects created by thrombi, as with radionuclide angiography, 3 Stratton JR, Ritchie JL Hammermeister KE Kennedy JW Hamilton GW Detection of left ventricular thrombi by radionuclide angiography. Am J Cardiol. 1981; 48: 565-572 Abstract Full Text PDF PubMed Scopus (37) Google Scholar x-ray computed tomographic scanning, 4 Nair CK Sketch MH Mahoney PD Lynch JD Mooss AN Kenney NP Detection of left ventricular thrombi by computerized tomography: a preliminary report. Br Heart J. 1981; 45: 535-541 Crossref PubMed Scopus (22) Google Scholar and two dimensional echocardiography. 1 Stratton JR, Ritchie JL Hamilton GW Hammermeister KE Harker LA Left ventricular thrombi: in vivo detection by indium-IH platelet imaging and two dimensional echocardiography. 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Circulation. 1982; 66: 156-166 Crossref PubMed Scopus (237) Google Scholar , 12 Green SE Joynt LF Fitzgerald PJ Rubenson DS Popp RL In vivo ultrasonic tissue characterization of human intracardiac masses, abstract ed. Circulation. 1981; 64: IV-256 Google Scholar These techniques provide somewhat complementary and overlapping clinical information and each has limitations. Indium-III platelet imaging, which is positive only if ongoing thrombosis is occurring, has the possible advantage over the other techniques of defining thrombus activity. In addition, it has a specificity approaching 100 percent but a lower sensitivity of approximately 70 percent. 1 Stratton JR, Ritchie JL Hamilton GW Hammermeister KE Harker LA Left ventricular thrombi: in vivo detection by indium-IH platelet imaging and two dimensional echocardiography. Am J Cardiol. 1981; : 874-881 Abstract Full Text PDF PubMed Scopus (69) Google Scholar 2 Ezekowitz MD Wilson DA Smith EO et al. Comparison of indium-III platelet scintigraphy and two-dimensional echocardiography in the diagnosis of left ventricular thrombi. N Engl J Med. 1982; 306: 1509-1513 Crossref PubMed Scopus (114) Google Scholar The identification of thrombi by radionuclide ventriculography is probably inferior to the other noninvasive techniques because of the limited resolution of gamma imaging systems. 3 Stratton JR, Ritchie JL Hammermeister KE Kennedy JW Hamilton GW Detection of left ventricular thrombi by radionuclide angiography. Am J Cardiol. 1981; 48: 565-572 Abstract Full Text PDF PubMed Scopus (37) Google Scholar X-ray tomographic scanning can detect thrombi, but the sensitivity and specificity are not currently defined. 4 Nair CK Sketch MH Mahoney PD Lynch JD Mooss AN Kenney NP Detection of left ventricular thrombi by computerized tomography: a preliminary report. Br Heart J. 1981; 45: 535-541 Crossref PubMed Scopus (22) Google Scholar