PMC5859800_01
(a) Coronary angiography showing the occlusion of the left descending artery in the proximal segment (arrow); (b) transthoracic 2-D echocardiography showing an apical ventricular thrombus; (c, d) cardiac magnetic resonance (CMR) unveiling the presence of two large left ventricular thrombi in the apex and along the anterior wall; (e) CMR TIR-T2 sequences showing myocardial edema involving the anterior wall of the left ventricle; (f, g) delay enhancement revealing scar, microvascular obstruction, and fibrosis (arrows); (h) CMR imaging: three hyperenhancement focal areas of fibrosis.
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fig1
The coronary angiography showed a normal right coronary artery and the occlusion of the left descending artery in the proximal segment (Figure 1(a)). Two mobile masses were found in the apex and in the anterior wall of the left ventricle, respectively (Figure 1(b)). CMR was performed at day three, confirming apex and anterior wall hypokinesia and 40% ejection fraction. CMR unveiled the presence of two LV thrombi in the apex and along the anterior wall, respectively (Figures 1(c) and 1(d)). TIR-T2 sequences showed myocardial oedema (Figure 1(e)) involving the LV anterior wall; delay enhancement (Figures 1(f) and 1(g)) revealed a thickness fibrosis in the same segment, with a hypoenhanced internal area suggesting microvascular obstruction. Three hyperenhancement focal areas were detected (Figure 1(h)): a transmural area at inferior apical septum, just beneath one thrombus, and two subepicardial areas, at anterior basal septum and at midanterior wall, respectively.