Clinical Characteristics, Treatment and Long-Term Outcomes of Patients with Right-Sided Cardiac Thrombus

A Dynamic Multimodality Imaging Assessment of Right Ventricular Thrombosis in a Middle-Aged Man with Lymphocytic Interstitial Pneumonia: The Additive Role of Tissue Doppler Imaging

Background: Right ventricular thrombosis (RVT) is rarely detected in clinical practice. Depending on its aetiology, RVT may originate from a deep venous thrombosis (type A) or in situ (type B). Type A is characterized by increased mobility and frequent pulmonary embolization, whereas type B is nonmobile and is associated with significant right ventricular (RV) dilatation and dysfunction. Methods: A type B RVT complicated by subsegmental pulmonary embolism (PE) was diagnosed in a 46-year-old man with acute-on-chronic respiratory failure secondary to acute exacerbation of interstitial lung disease. He underwent a multimodality imaging assessment of the RV mass that comprehensively incorporated TTE, TEE, contrast-enhanced chest CT, and LGE-CMR. Results: During the clinical course, a serial echocardiographic assessment of the RV mass allowed for a dynamic evaluation of its features and cardiac haemodynamics. Conventional TTE was implemented with colour tissue Doppler imaging (TDI) and pulsed wave (PW) TDI to improve the visualization of the RV mass and to objectively measure its mobility. The increased RVT mass peak antegrade velocity (>10 cm/s) was predictive of subsequent RVT fragmentation and PE. Conclusions: Colour TDI and PW-TDI may aid in the differential diagnosis of RV masses and may improve the prognostic risk stratification of patients with right-sided intracardiac masses.

Right and Left Ventricle Thrombus in a 68-Year-Old Patient With Sepsis and Cardiomyopathy

Right ventricular thrombus (RVT) is a rare but clinically significant condition associated with severe complications, such as pulmonary embolism and right heart failure. This case report presents a 68-year-old woman with a history of diabetes, coronary artery disease, and heart failure with reduced ejection fraction (HFrEF), who developed bilateral ventricular thrombi in the context of septic cardiomyopathy secondary to a diabetic foot infection and a urinary tract infection (UTI). Echocardiography revealed thrombi in both the right and left ventricles, severe global hypokinesia, and reduced ejection fraction. The patient was treated with intravenous heparin and showed symptomatic improvement. Diagnostic challenges in RVT were highlighted, emphasizing the limitations of echocardiography in differentiating cardiac masses and the superior diagnostic capabilities of cardiac magnetic resonance imaging (CMR). This case underscores the importance of early diagnosis, individualized management strategies, and the utility of advanced imaging techniques in RVT.

Differential diagnosis of thrombosis and myxoma in unusual heart positions by dual-energy CT multiple parameter imaging: A case series

RATIONALE

Thrombus is the most common occupying lesion in the cardiac chambers, it is often distinguished from cardiac neoplastic occupations. Among them, the most common is cardiac myxoma, whose imaging manifestations are often confused with thrombus. However, the 2 types of lesions have different therapeutic strategies and are both potentially high-risk sources of embolism, so early differentiation between intracardiac thrombus and cardiac tumor is essential. In this study, we intend to investigate the value of dual-energy computed tomography (CT) in the differential diagnosis of cardiac thrombus and myxoma by retrospectively analyzing the dual-energy CT-related parameters of 2 cases of intracardiac thrombus and 1 case of cardiac myxoma.

PATIENT CONCERNS

Three cases of masses located in uncommon areas of the heart with comparable imaging characteristics are presented in this study.

DIAGNOSES

Echocardiography revealed an isoechoic mass in the cardiac chambers, while CT scans showed a hypodense occupancy with varying morphologies. Postoperative pathology or follow-up after treatment confirmed 1 case as a right ventricular thrombus, another as a right atrial thrombus, and the third as a right ventricular myxoma.

INTERVENTIONS

In this study, we conducted a retrospective analysis of dual-energy CT-related parameters in 2 cases of intracardiac thrombus and 1 case of cardiac myxoma.

OUTCOMES

Our findings indicate notable differences in the slopes of the energy spectral curves, mean iodine density, and effective atomic number between the intracardiac thrombus and myxoma cases.

LESSONS

Drawing upon existing literature, we propose combining different quantitative analysis methodologies to create a more objective foundation for distinguishing between cardiac thrombosis and myxoma.

A case report of right ventricular defibrillator and left bundle branch area leads placement and atrioventricular node ablation with chronic right ventricular thrombus

Despite lack of concrete evidence, right ventricular thrombus is generally considered to be a contraindication for intracardiac lead placement. We present a case of successful placement of a right ventricular defibrillator lead and left bundle branch pacing lead and atrioventricular node ablation in a patient with chronic right ventricle thrombus.

Multiple thrombi mimicking metastases in the right atrium of patients with non-Hodgkin's lymphoma diagnosed by multimodal cardiac imaging: one case report

BACKGROUND

Right-side heart mass can be found incidentally on routine transthoracic echocardiography (TTE). Accurate diagnosis of cardiac mass often requires more than one imaging method. We present a mid-age woman with non-Hodgkin lymphoma who was found to have multiple right atrial masses mimicking metastases on routine TTE, which were finally diagnosed as thrombi by multimodal cardiac imaging.

CASE PRESENTATION

A 52-year-old woman was diagnosed with primary mediastinal diffuse large B cell lymphoma (DLBCL) almost six months prior. The TTE revealed multiple masses in the right atrium with normal cardiac function when she was being evaluated for the next chemotherapy. On arrival, she was hemodynamically stable and asymptomatic. Physical examination was no remarkable. Laboratory findings showed leukocytosis of 17,900 cells/mm3, hemoglobin of 7.5 mg/dL, and a normal D-dimer level. The suspicious diagnosis of right atrial metastasis was made by TEE. However, the diagnosis of right atrial thrombi was made by contrast CMR. Finally, the 18 F-FDG PET-CT demonstrated no metabolic activity in the right atrium, which further supported the diagnosis of thrombi. Eventually, the masses were removed by cardiopulmonary bypass thoracotomy because of a high risk of pulmonary embolism. Histopathology confirmed the diagnosis of thrombi.

CONCLUSIONS

This case highlights the importance of multimodality cardiac imaging in the appropriate diagnosis of a RA masses in patient of lymphoma. Diagnosis of RA masses can be made using multimodal cardiac imaging like TTE, TEE and CMR, even PET. Echocardiography is the most commonly used on multimodal imaging in cardiac thrombus. CMR has high specificity in differentiating a tumor from thrombus, while 18 F-FDG PET has good sensitivity to determine the nature of the masses.

Diagnostic and therapeutic challenge: A case of right ventricular thrombus

Right ventricular thrombus is a rare finding found in 4% of people diagnosed with pulmonary embolism. Although right ventricular thrombi are usually associated with atrial fibrillation, deep venous vein thrombi, or intracardiac procedures, isolated right ventricular thrombi are rare. Right ventricular thrombus has also been reported in patients with right ventricular infarction, as hypokinesis of the right ventricle causes blood stasis and promotes thrombosis as per Virchow's triad. However, we present a case of isolated RV thrombus in a patient without evidence of deep vein thrombosis or right ventricular hypokinesis who presented with dyspnea on exertion.

Right Ventricular Thrombus on Echocardiography

Right ventricular thrombi (RVTs) have been almost exclusively studied in patients with pulmonary embolism (PE). The implications of an isolated RVT, a finding typically encountered on transthoracic echocardiography (TTE), are lacking. In this study, we sought to identify the echocardiographic and clinical features associated with the presence of RVTs. Between 1998 and 2023, 138 patients with RVT documented on TTE were retrospectively identified. Demographic data, presence of intracardiac devices, hypercoagulable conditions, history of deep vein thrombosis (DVT), PE, and/or left ventricular thrombus were abstracted from electronic chart review. Measurements of right and left ventricular size, and function were performed on TTE. Of the total population of patients with RVT, <1/2 had intracardiac devices, 29% had a documented hypercoagulable state (e.g., cancer or a clotting disorder). Most patients had dilated (77%) and dysfunctional (72%) right ventricles. Approximately 50% of RVTs were discovered in nonstandard imaging planes, suggesting that the presence of RVT is likely underestimated in clinical practice. Of those evaluated for PE, 80% had PE. Of those evaluated for DVT, 53% had DVT. In conclusion, further investigations are warranted to better guide when to investigate the right ventricle for RVTs on TTE and the impact of RVTs on patient outcomes.

A Right Ventricular Mass With Intracavitary Obliteration: Tumor or Thrombus?

A 47-year-old woman was admitted to the hospital because of dyspnea for the past three months. She was previously diagnosed with pulmonary embolism. She had been operated on for a colon tumor five years ago and no residual cancer was detected on oncological follow-up. Her transthoracic echocardiographic and transesophageal echocardiographic evaluation showed a hypertrophic right ventricle occupied by a 2.7 x 4.8 cm immobile mass obliterated to the right ventricle cavity. All the non-invasive tests were consistent with thrombus prediagnosis. She underwent surgery. Mass was resected from the right ventricle as much as possible. Histopathology of surgical material revealed metastatic spindle cell adenocarcinoma. We aim to increase the awareness of the differential diagnosis of thrombus or tumor, thereby leading to appropriate management.