CTICasesCOVID-19 Thrombotic State with Myocardial Infarction and LV Thrombus
Imaging findings
A man around 60 with multifocal patchy COVID-19 consolidation and a small pulmonary embolus has striking cardiac findings on the PE-protocol CT: a dilated left ventricle with a large LV thrombus, a large inferior wall transmural infarct with aneurysm, and an apical aneurysm, with right ventricular involvement. Cardiac MRI confirmed the transmural infarcts and aneurysm.
Key takeaways
COVID-19 can produce a severe hypercoagulable and vasculopathic state with pulmonary emboli, coronary events (plaque rupture or COVID-related vascular injury), transmural myocardial infarction with aneurysm, and rapid formation of left ventricular thrombus in akinetic segments. The diagnosis of the infarct and aneurysm can often be made from the CT alone, and the constellation reflects the thrombotic complications of the infection rather than the pneumonia itself.
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