Magnetic Ressonance in the Evaluation of cardiac thrombi - a clinical case r

Abstract

Cardiac Magnetic Resonance Imaging (CMRI), due to its high spatial resolution and ability to characterize tissue, has taken on a key role in the detection and characterization of intracardiac thrombi, allowing for a more accurate assessment of their composition (fresh/organized). Correct diagnosis of thrombi is essential for appropriate therapeutic management and for the prevention of thromboembolic events.

This clinical case refers to a 61-year-old male patient with acute myocardial infarction complicated by cardiogenic shock and subsequent suspicion of an apical thrombus. The diagnosis was made via CMRI, which allowed for the identification and characterization of the lesion using a multiparametric protocol, including cine-SSFP (Steady-State Free Precession) sequences, late gadolinium enhancement (LGE), and T1 mapping.

CMRI revealed a hypointense apical mass without contrast enhancement on late gadolinium enhancement sequences, consistent with a left ventricular thrombus. The reduced T1 values suggested a recent thrombus with some signs of organization. Based on these findings, anticoagulant therapy was initiated, resulting in significant regression of the thrombus after three months of follow-up.

This clinical case highlights the decisive role of CMRI in the evaluation of post-infarction complications, allowing not only the accurate diagnosis of intracavitary thrombi but also their tissue characterization, which impacts treatment decisions.