Calcified left ventricular apical thrombus

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Veteran with a history of smoking cigarettes and cannabis had a new patient physical and for which a chest radiograph was ordered.

Patient Data

Age: 65 years
Gender: Male

There is a 3 cm well circumscribed calcified lesion at the ventricular apex.

Recommend cardiology evaluation.

CT

Cardiac Gated CTA

A retrospective cardiac gated CTA with calcium score confirmed a large calcified lesion at LV apex. It is most likely a calcified thrombus. No obvious apical aneurysm was seen,

Case Discussion

The patient did not have a known history of coronary artery disease (CAD) but was at high risk for CAD due to the history of tobacco abuse and drug abuse. He was referred to cardiology for further investigation and management.

Differential diagnosis:

  1. Not a coronary artery aneurysm or a hydatid cyst or calcified fibroma based on CTA findings.
  2. Since it is internal with no focal outpouchings, it is more likely a calcified thrombus rather than an apical calcified LV aneurysm.

The patient was referred for an echocardiogram and cardiac MRI.

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Case information

rID: 68401
Published: 30th May 2019
Last edited: 2nd Jun 2019
Inclusion in quiz mode: Included
Institution: Augusta University

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