CTICasesDoxorubicin-Induced Cardiomyopathy with Bi-Ventricular Thrombi
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Imaging findings
Serial chest radiographs show progressive cardiomegaly, an elevated right hemidiaphragm, and a left pleural effusion over six months. Echocardiography and cardiac MRI demonstrate severe biventricular dysfunction with a left ventricular ejection fraction of 15% (previously normal). Cardiac MRI shows multiple intracardiac filling defects consistent with thrombi in the left ventricular apex and the right atrium.
Key takeaways
Doxorubicin (Adriamycin) is a highly cardiotoxic chemotherapeutic agent that can induce rapid-onset, severe dilated cardiomyopathy. The severe biventricular hypokinesis and low ejection fraction significantly increase the risk of intracardiac thrombus formation in the ventricles or atria. Patients undergoing anthracycline therapy require regular echocardiographic or cardiac MRI surveillance to detect early-onset dysfunction and initiate cardioprotective therapy and anticoagulation.
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