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

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

Modality: X-ray

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

Modality: Annotated image

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

Modality: 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.

Modality: 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: Cardiac, Chest
Inclusion in quiz mode: Excluded

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