CTICasesMyocardial Lipomatous Metaplasia and Left Ventricular Pseudo-Thrombus
Imaging findings
CT chest shows focal fat replacement (lipomatous metaplasia) in the left ventricular apex and interventricular septum. A low-attenuation apical filling defect on arterial phase is shown to completely fill with contrast on portal venous phase.
Key takeaways
Lipomatous metaplasia is a marker of chronic, healed myocardial infarction. The dysfunctional, dyskinetic apical wall leads to local blood stasis (smoke phenomenon), presenting as an arterial phase filling defect (pseudo-thrombus) that disappears on delayed phase scans.
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