Rare Visualization of Entrapped Left Ventricular Thrombi in Noncompacted Myocardium
A 64-year-old man with no significant medical history presented to the emergency department with severe acute heart failure. Initial management was based on oxygen therapy, diuretics, and nitroglycerin. Twenty-four hours after admission, the patient developed aphasia and left arm weakness. Brain MRI showed multiple strokes (Figure A) compatible with cardiac emboli. Echocardiography showed dilated cardiomyopathy with severe left ventricular (LV) dysfunction (ejection fraction, 15%). The presence of large trabeculations at the apex and posterolateral wall (Figure B, online-only Data Supplement Videos 1 and 2) more clearly visualized with contrast imaging (online-only Data Supplement Video 3) suggested the diagnosis of LV noncompaction. A zoomed-in view of the LV apex revealed a thrombus entrapped within these trabeculations (Figure C, online-only Data Supplement Video 4). Cardiac MRI confirmed the diagnosis of LV noncompaction and the presence of 2 thrombi (Figure D).
LV noncompaction is considered to be associated with a higher risk of peripheral emboli than of other cardiomyopathies. In addition to LV dysfunction, blood flow is extremely sluggish within the noncompacted myocardium, increasing the risk of intracardiac thrombi. In a series of 34 patients with LV noncompaction followed for 44 months, thromboembolic events occurred in 24%.1 However, to our knowledge, this case is only the second report2 of direct visualization of a thrombus entrapped within noncompacted myocardium.
The online-only Data Supplement is available at http://circheartfailure.ahajournals.org/cgi/content/full/4/3/e9/DC1.
- Received January 28, 2011.
- Accepted March 8, 2011.
- © 2011 American Heart Association, Inc.