Two- and three-dimensional echocardiographic imaging of massive left intraventricular thrombosis complicating fatal heart failure

These images describe a case of massive left ventricular (LV) thrombosis complicating fatal heart failure in a 61 year-old patient with history of myocardial infarction, apical aneurysm, and no previous evidence of LV thrombosis. Two-dimensional echocardiography showed that the thrombus obliterated 34% of LV volume at end-diastole. Three-dimensional echocardiography allowed higher definition of thrombus architecture and dimensions, revealing obliteration of 40% of LV volume at end-diastole. Careful assessment of thromboembolic risk to guide therapeutic decision making should be considered mandatory in subjects with a large extent of wall asynergy, even in those with no previous evidence of LV thrombosis. Three-dimensional echocardiography may be considered an accurate technique for the characterization of LV thrombi in these patients.