E-page Original Images: Calcified ball- like left ventricular thrombus embolized during echocardiography follow-up

A 48-year-old male was admitted to our cardiology department with complaints of dyspnea and palpitations for ten days. He had smoking history for 30 years as a risk factor for coronary artery disease. The patient was tachypneic and cyanotic; his blood pressure was 100/80 mmHg, pulse rate - 130 beats/min and respiratory rate was 25/min. On cardiovascular examination, a grade 2/6 systolic murmur was heard at the left sternal border. Electrocardiogram showed atrial fibrillation with anterior QS pattern. There was a mild leukocytosis and troponin level was 0.5 ng/dl. There was a cardiomegaly on telecardiography and transthoracic echocardiography demonstrated mild mitral regurgitation and global left ventricular (LV) hypokinesia with LV ejection fraction of 25%. Besides, there was a huge calcified ball-like mass (2.7 cm x 3.0 cm) in the LV apex. Urgent cardiac surgery was planned for thrombus removal. A second echocardiography follow- up was done before the cardiac surgery. During that time, he had begun to describe a severe abdominal pain and general surgeons were called for consultation. We re-evaluated the patient by echocardiography with the suspicion of embolization of the thrombus.