Intracardiac thrombus with bilateral pulmonary embolism

Case contributed by Dr James Harvey

Presentation

Presented to GP with 3 week history of cough, shortness of breath, abdominal distension and pedal edema.

Patient Data

Age: 55 years
Gender: Male

Bilateral pulmonary emboli. A wedge-shaped area of parenchymal change within the peripheral left lung base may indicate developing pulmonary infarct or hemorrhage.

There is transverse cardiomegaly and a low density (~55HU) thrombus is seen within the left ventricular apex.

Moderate volume of bilateral pleural effusions.

Case Discussion

Intracardiac thrombi may develop after myocardial infarction or in patients with atrial fibrillation. Left ventricular thrombus typically follows an anterior myocardial infarction, whereas left atrial appendage thrombus is more common in patients with atrial fibrillation. Specific factors which may lead to ventricular thrombus include aneurysm of the ventricle wall and severe regional wall motion abnormalities.

Morphology and clot density should distinguish the intracardiac thrombus from normal papillary muscle.

This patient was urgently referred to hospital for cardiology review. He underwent an echocardiogram which proved the presence of a patent foramen ovale.

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