Case Report "Apical Thrombus*"

Jeanette Schulz-Menger, M.D.; Philipp Boye, M.D.; Franz Volhard Clinic
Charité Campus Buch, Berlin, Germany

This 72-year-old patient was referred to cardiology department with subacute myocardial infarction. The patient had had coronary artery bypass graft surgery in 1999 (grafts to right coronary artery and left anterior descending). One day prior to the MRI exam, a stent was placed in the coronary artery bypass graft to the LAD.

Dilated, hypertrophic left ventricle with moderately reduced ejection fraction. Tissue characterization sequences show increased intensity in the anterior wall and basal inferior and posterior wall. The TIRM sequence shows edema in anterior wall but no edema in the basal inferior and posterior wall (Fig. 1). In LVOT orientation, an apical left ventricular thrombus with a liquid core can be seen. Follow-up investigation after 3 months of anticoagulation revealed complete resolution of the thrombus (Fig. 3).

Fig. 1

Cardiac MRI can be used for a comprehensive cardiac examination of patients with coronary artery disease. Beyond assessing global and regional wall motion abnormalities by use of cine-sequences, CMR reveals in this patient the presence of an apical thrombus, helps differentiating between acute and chronic infarction by use of a PSIR (Phase-Sensitive Inversion-Recovery) and TIRM (Turbo Inversion Recovery Magnitude) sequences. Both sequences used together improve the performance of CMR in the acute setting.

*The information about this product is preliminary. The product is under development. It is not commercially available in the US and its future availability cannot be assured.