Discussion
Conventional treatment of thrombosed LV aneurysm including
antithrombotic treatment to reduced the incidence of systemic embolism
and mortality[2]. While IDH is a very rare
presentation of cardiac rupture, the antithrombotic treatment may cause
deadly tamponade. Thus, Early identification and prompt treatment is
crucial in management for both diseases.
Conventional echocardiography, which is sensitive and specific in the
diagnosis of thrombosed LV aneurysm. In general, the endocardial flap
and the communication of intracavitary helps distinguish the IDH from
the thrombosed LV aneurysm. However, in this case, the shape and the
high-activity of the thrombosed LV aneurysm was similar to the cavity
caused by IDH. This condition could caused much difficulty for us, and
making a definitive judgment was thereby challenging.
Contrast echocardiogram is better than plain echocardiogram in
identifying thrombosed LV aneurysms and increases the
sensitivity and specificity for the diagnosis of mural thrombi. CMR is
the most sensitive and specific study for identifying and assessing
thrombosed LV aneurysm preoperatively. To confirm the diagnosis, the
contrast echocardiogram and CMR were performed. What were the findings
in our patient? There were no ultrasound contrast agents entering into
the small chamber (Figure1E). Similarly, magnetic resonance first pass
perfusion imaging revealed an abnormal signal intensity area in the
apex, which was not enhanced (Figure1H). Therefore, we preliminarily
concluded that the patient suffered from a thrombosed LV aneurysm rather
than an IDH.
Similar case like this has not been reported in previous studies.
However, the indication for aneurysmectomy is certain because previous
studies have showed that aneurysmectomy might improve the
outcome[4,5]. Therefore, we proposed a surgery
treatment strategy. After sugery, our patient did not experience any new
impairment of his functional status, neither with complex arrhythmias
nor with thrombotic events.
In conclusion, it is sometimes difficult to distinguish a thrombosed LV
aneurysm from IDH by conventional echocardiography if the thrombus shape
changes. A definitive diagnosis involves multimodal imaging.