PMC5794369_01
Serial echocardiographic images in the identification of a left ventricular thrombosis-like mass. (A) Identification of a thrombus at the left ventricular apex during the initial echo examination, leading to the initialization of rivaroxaban (10 mg daily) treatment. Crossed lines surrounded the thrombus-like mass, which is also indicated by an arrow. (B) After 15 days of treatment, the size of the thrombus was reduced. (C) At 45 days of anticoagulation therapy, the size of the thrombus was further reduced. (D) The thrombus had diminished after 3 months, revealing suspected increased intratrabacular recesses of the heart (blue arrows). (E) Doppler imaging revealed a "flushed" pattern of blood flow into the myocardium.
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F1
The size of the mass was measured as 1.10 cm x 2.43 cm (Fig. 1A). During the follow-up after 15 days, 45 days and 3 months, the size of the thrombus got decreased and vanished at the 3-month follow-up (Fig. 1B-D). As the thrombus was gone, echocardiographic assessment revealed a suspected left ventricular non-compaction cardiomyopathy (Fig. 1D and E).
Cardiac magnetic resonance image showing evidence of ventricular non-compaction. Arrows indicate the non-compacted ventricle. The ratio between non-compaction to compaction of the ventricular myocardium is >2.3 at the end of diastole, which is one of the diagnostic criteria for LVNC.
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F2
A follow-up cardiac magnetic resonance exam found hyper-trabeculation of the myocardium at apex and free wall (Fig. 2 and Online appendix A and B), which confirmed the diagnosis of LVNC.