R3 Song Se-bin

Lt. ventricular thrombi  Typically amormphous, echogenic structure with variable shape and adherent to the endocardium  May be multiple, mobile and protrude into the left ventricular cavity  Generally involve the apex of the left ventricle in presence of akinesia or dyskinesia  May be difficult in differentiating between thrombi and myocardium

Etiology  Low flow  Blood flow stasis  Recent myocardial infarction  Lt. ventricular aneurysm  Dilated cardiomyopathy

Echocardiography of LV thrombus  TTE  Sensitivity 75~95%  Lamina thrombi not protruding  -> likely to be missed  Modified apical transducer position  Tangential or off-axis view  Contrast imaging

Misdiagnosis  Apical hypertrophy  Endocardial fibroelastosis  Hypereosinophilic syndrome -> dense endocardial fiborsis -> bright appearance of both mass and underlying myocardium  Ventricular noncompaction  Sponge like appearance, ‘Swiss cheese-like’ appearance  Color flow within lesion  Muscle trabeculation  Tumor or vegetation

Journal of Clinical Ultrasound, 2003, 31(8):