Differential diagnosis of left ventricular mural thrombi by myocardial contrast echocardiography - A preliminary study

Two-dimensional echocardiography has become the procedure of choice to diag nose left ventricular mural thrombi. However, small or flat thrombi may be difficult to distinguish from myocardium. The spatial distribution of the v entricular myocardial blood flow can be imaged with myocardial contrast ech ocardiography (MCE). The authors presumed that the absence of arterial supp ly to a fresh thrombus may allow MCE to distinguish between thrombus and my ocardium. In the 2 cases presented here, MCE was performed with the same te chnique as that used for the purpose of visualization of myocardial perfusi on; as a result, an epical mural thrombus, indistinct from myocardium befor e MCE, was visualized as a contrast defect during imaging. Conversely, myoc ardium that mimicked a thrombus was imaged by MCE as a contrast-opacified a rea. These findings suggest that MCE after reperfusion therapy is useful to distinguish mural thrombi from myocardium.