Fig. 22.1
Lateral and frontal radiographs of the chest in a young adult patient show right atrial calcified thrombus (arrows) in a patient with atrial fibrillation
Fig. 22.2
Axial image from a contrast-enhanced chest CT in a young adult shows calcified and noncalcified thrombus in the distal IVC
22.2.2 Echocardiography Findings
Transthoracic echocardiography is the diagnostic tool of first choice if there is an adequate window, but it may not be possible to visualize all chambers of the heart. Because of the limited transthoracic window in some patients, transesophageal echocardiography has emerged as the most sensitive modality for the detection of intracardiac thrombi.
22.2.3 MRI Findings
T2-weighted and short TI inversion recovery (STIR)
Sarcoidosis may demonstrate focal or diffuse myocardial hyperintensity due to edema with ventricular wall thinning
Sensitive in detecting iron deposition within the myocardium in siderotic cardiomyopathy
Steady-state free precession (SSFP) cine MRI
Can provide a good overall cardiac assessment in looking for thrombus and can aid in further targeting in areas that appear suspicious
Can help visualize akinetic or hypokinetic myocardium that can predispose patients for development of intracardiac thrombus
Gating the heart may be limited in patients with atrial fibrillation
Early gadolinium enhancement
Thrombus does not enhance like normal myocardium, so the thrombus shows a comparatively low signal intensity
A long inversion time to null any nonvascular thrombus is helpful to accentuate the differences between clot and infarction or fibrosis
Delayed gadolinium enhancement (>10 min)
Thrombus will remain low in signal intensity, whereas any underlying infarcted myocardium will show delayed enhancement
22.2.4 CT Findings
The lack of contrast enhancement is an effective tool for differentiating tumor from thrombus
Gated CT may visualize all intracardiac chambers, but it is limited in patients with atrial fibrillation
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