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Case Reports
. 2008 Aug;24(8):e51-3.
doi: 10.1016/s0828-282x(08)70655-x.

Biventricular apical thrombi demonstrated by contrast-enhanced cardiac MRI following anteroapical STEMI and unsuccessful reperfusion therapy

William Keeble  1 , Isabelle Vondermuhll, Ian Paterson
Affiliations
Case Reports

Biventricular apical thrombi demonstrated by contrast-enhanced cardiac MRI following anteroapical STEMI and unsuccessful reperfusion therapy

William Keeble et al. Can J Cardiol. 2008 Aug.

Abstract
in English, French

Contrast-enhanced cardiac magnetic resonance imaging can define the territory and extent of myocardial infarction from patterns of late gadolinium enhancement. Following failure to reperfuse with thrombolytic therapy, a case of myocardial infarction is described in which ongoing symptoms and an electrocardiogram change led to a diagnostic dilemma. Cardiac magnetic resonance imaging confirmed an apical infarction, an aneurysm and acute pericarditis. In addition, late gadolinium enhancement unexpectedly revealed the presence of biventricular apical thrombi. The prevalence of cardiac thrombi and pulmonary emboli may be greater than generally appreciated.

L’imagerie par résonance magnétique cardiaque à contraste rehaussé permet de définir le territoire et l’ampleur de l’infarctus du myocarde à partir de l’image de phase tardive rehaussée par le gadolinium. Après l’échec de la reperfusion par thrombolytiques, on décrit un cas d’infarctus du myocarde au cours duquel les symptômes persistants et les changements à l’ÉCG ont mené à un dilemme diagnostique. L’imagerie par résonance magnétique cardiaque a confirmé un infarctus apical, un anévrisme et une péricardite aiguë. De plus, la phase tardive du rehaussement au gadolinium a révélé de manière imprévue la présence de thrombi apicaux biventriculaires. La prévalence des thrombi cardiaques et des embolies pulmonaires pourrait se révéler plus forte qu’on ne l’a généralement cru.

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Figures

Figure 1)
Figure 1)
Electrocardiogram after failure to reperfuse 90 min after tenecteplase administration. Persistent anteroapical and inferior ST segment elevations were seen
Figure 2)
Figure 2)
A Coronary angiogram performed in left anterior oblique 60° view. The termination of the small (<2 mm), tapering distal left anterior descending coronary artery (LAD) was uncertain. B Dominant right coronary artery. Posterior descending artery (PDA) supplies inferior wall. C Left ventriculogram in diastole. D Apical aneurysm evident in systole. D1 First diagonal; AVCx Atrioventricular groove circumflex artery; OM Obtuse marginal; RV Right ventricular
Figure 3)
Figure 3)
Four-chamber cardiac magnetic resonance imaging studies performed on day 4 of admission. A Systolic frames obtained from a fast imaging steady-state, free precession sequence showing aneurysmal left ventricular (LV) and right ventricular (RV) apexes. B Diastolic still frame demonstrating normal ventricular and atrial dimensions. C Still frame from late contrast-enhanced two-dimensional inversion recovery, gradient echo, fast low angle-shot magnetic resonance sequence. Late gadolinum enhancement (LGE) was consistent with myocardial infarction of the cardiac apex. Thrombi appeared as low signal intensity filling defects in both ventricular apexes
See this image and copyright information in PMC

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