Saranteas et al used transthoracic echocardiography (TTE) to identify a left ventricular thrombus in a patient following surgery. The authors are from the University of Athens and Attikon Hospital of Athens in Greece.


Patient selection: following major surgery


Risk factors for a left ventricular thrombus:

(1) cardiomyopathy (ischemic, dilated, other)

(2) acute myocardial infarction

(3) other low flow condition

(4) hypercoagulable state

(5) central venous catheter

(6) absence of anticoagulation


Features seen on echocardiography:

(1) located at the cardiac apex

(2) associated with akinetic or dyskinetic cardiac wall

(3) soft and uncalcified

(4) pedunculated

(5) mobile


The left ventricle is examined using:

(1) the apical 4-chamber view

(2) scanning the apex in the short-axis parasternal view


Additional technical points:

(1) A thin, fixed mural thrombus can be missed.

(2) Poor technical quality or limited experience can reduce detection.

(3) Contrast agents can improve detection of borderline lesions.


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