IMAGES IN EMERGENCY MEDICINE
Pedunculated left ventricular thrombus presenting with acute ischaemic limb
1 Department of Cardiology, St George’s Hospital, London, UK
2 Department of Cardiology, London Chest Hospital, London, UK
3 Department of Cardiology, Colchester General Hospital, Essex, UK
Correspondence to:
Dr Z Chen, Department of Cardiology, St George’s Hospital, Blackshaw Road, London SW7 OQT, UK; zchenuk@yahoo.co.uk
Accepted 26 April 2007
| The first 150 words of the full text of this article appear below. |
An 84-year-old man presented with acute ischaemia of the left lower limb. He had an anterior myocardial infarction 8 years ago and longstanding atrial fibrillation. He had previously been receiving warfarin, which was stopped a year ago after a fall. The patient underwent emergency left above-knee amputation after unsuccessful femoral embolectomy. Transoesophageal echocardiography confirmed a well-circumscribed pedunculated mobile mass protruding from the left ventricular wall (
figs 1 and 2). Echographically it was difficult to determine if the mass was a thrombus or a tumour. The patient underwent emergency cardiac surgery for evacuation of the mass. Histology confirmed the mass was a thrombus.
Figure 1 Pedunculated left ventricular mass on transoesophageal echocardiography.
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Figure 2 Macroscopic appearance of the left ventricular mass.
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Despite advancement in post-myocardial infarction management which aims at preserving left ventricular function, thrombus formation remains a common complication, especially in patients with a dilated, aneurysmal ventricle with advanced wall motion abnormality.
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