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(Circulation. 2009;120:e8-e10.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Live Echocardiographic Visualization of the Migration of a Voluminous Left Ventricular Thrombus Complicating an Acute Myocarditis

Falah Aboukhoudir, MD; Sofiene Rekik, MD; Jean Lou Hirsch, MD

From the Cardiology Department, Avignon Hospital Center, Avignon, France (F.A., S.R., J.L.H.), and Cardiology Department, University Hospital Hedi Chaker, Sfax, Tunisia (S.R.).

Correspondence to Sofiene Rekik, MD, Service de Cardiologie, Centre Hospitalier d’Avignon, 305, rue Raoul Follereau, Avignon, France. E-mail sofienerek@yahoo.fr

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 52-year-old man was referred to our intensive care unit by the emergency department for chest pain and severe recent-onset dyspnea. The patient had no particular medical history and no cardiovascular risk factors. His complaints started 3 weeks previously after what he described as a severe flu with cough and fever.

At clinical examination, the patient was breathless with a respiratory rate of 28 cycles per minute and a fever of 38.3°C. His heart rate was 88 bpm and blood pressure was 112/68 mm Hg. Pulmonary auscultation revealed bilateral wet rales in the lower lung fields. An ECG showed no particularities. Biology found a frank inflammatory syndrome with an erythrocyte sedimentation rate of 90, a C-reactive protein of 180 mg/L, and a white blood cell count of 14 500. His troponin I level was 6.4 mg/L and BNP level was 6788 pg/mL.

Transthoracic echocardiography performed at admission (Figure 1 and Movie I of the online-only Data Supplement) showed a severely depressed left ventricular function with an ejection fraction of 30%, along with a massive apical adherent thrombus. Another spherical, highly mobile, pedunculated thrombus was observed, as well as a circumferential pericardial effusion and an important pleural effusion.

View larger version (100K):   Figure 1. Two-dimensional transthoracic echocardiogram in the apical 4-chamber view demonstrating a highly mobile and pedunculated thrombus located in the apex of the left ventricle.

Given the potentially high risk of distal embolization, an urgent surgery was discussed; meanwhile, the patient was treated with unfractionated heparin. A second echocardiographic control was performed . . . [Full Text of this Article]