LV thrombus

Q: After myocardial infarction which modality of transthoracic echo (TTE)  is preferred to detect left ventricular thrombus?

A) contrast 
B) non-contrast 


Answer: B

Many hospitals electronic system order TTE as non-contrast by default. The teaching point of this question is to highlight the addition of contrast to TTE.

Although the specificity of both non-contrast and contrast TTE is almost 100% to detect LV thrombus, the sensitivities are way low. The sensitivity to detect LV thrombus with non-contrast TTE is only 35 percent despite it is a thrombus, which is expected to be easily visualized. Adding contrast increases it up to 64 percent.


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Reference:

Srichai MB, Junor C, Rodriguez LL, et al. Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J 2006; 152:75.