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Findings: Images through the cardiac chambers show an irregular, low density filling defect within the right ventricle. Images at the level of the pulmonary outflow tract show extension of the filling defect into the main pulmonary artery.
Diagnosis: Large intraventricular thrombus of the right ventricle, with subsequent embolization.
Discussion: The differential diagnosis of intracardiac masses include primary and metastatic tumors, with metastatic disease being 10-40 times more common. The most common intracardiac tumor is a myxoma, with approximately 75% in the left atrium.
There is a relative paucity of literature on imaging of intraventricular thrombus. Godwin et al. reported a series of five cases of intraventricular thrombus. Four of those were in the left ventricle, and related to prior myocardial infarction. One patient had a right ventricular thrombus, probably secondary to placement of a pericardial patch over the right ventricle.
Tomoda et. al. studied a series of 21 patients with evidence of myocardial infarction. In three of these patients, left ventricular thrombus was identified and correlated well with echocardiographic results. there were no reported right ventricular thrombi.
References:
Churchhill, RJ. Computed Tomography of the Heart.In Haaga,JR Lanzieri,
CF, Sartoris,DJ and Zerhouni, EA Computed Tomography and Magnetic Resonance of
the Whole Body. St. Louis, 1995,Mosby, p. 836.
Godwin JD et al Detection of Intraventricular Thrombi by Computd Tomography.
Radiology 138: 717-721, 1981.
Tomoda, H, et al: Evaluation of Left Ventricular Thrombus With Computed Tomography.
Am J. Cardiology 48: 573-577, 1981.
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