Left ventricular mass lesion

Case contributed by Dr Jayanth Keshavamurthy

Presentation

62 year old got preoperative chest radiograph for hernia surgery. Prior CAD, CABG and coronary stent.

Patient Data

Age: 62
Gender: Male
X-ray

What complication do you see here? Where is the problem? Which chamber of the heart?

Chest radiograph shows pericardiac calcification, coronary artery calcification and a 2.7 by 3 cm soft tissue density mass overlying the left ventricle posteriorly. 

Annotated image

2.7 by 3 cm soft tissue density mass overlying the left ventricle posteriorly. Pericardiac calcifications, Sternotomy changes seen,

DSA (angiography)

On prior cardiac catheterization 10 month before, LIMA graft to the LAD was patent. There was chronic total occlusion of left circumflex coronary artery stent.  There is a similar sized mass in the left ventricle. This does not fill like an aneurysm. This could be a non calcified stable thrombus in the left ventricle, a known complication of old myocardial infarction.

Ultrasound

There appears to be a discrete area with increased echogenicty adjacent of the scarred inferior/inferolateral wall of the LV measuring 4.3 x 1.6cm; this appears to be more likely extracardiac with intracardiac or intramural locations being less likely.

Considerations include old organized thrombus related to old infarction (small rupture), surgery related scarring; intracardiac thrombus vs tumor. Additional imaging with CT or MRI may be helpful.

Case Discussion

LV thrombus was common before thrombolysis era. Current incidence is 5-8% with anterior wall MI.

ECHO was done based on chest radiograph report. No cross section imaging done so far.

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Case information

rID: 38986
Case created: 14th Aug 2015
Last edited: 8th Nov 2015
Systems: Chest, Cardiac
Inclusion in quiz mode: Excluded

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