CTICasesHIV-Associated Myocarditis with Left Ventricular Thrombus
Imaging findings
CT pulmonary angiogram demonstrates a dilated heart with suboptimal left-sided opacification. A subsequent venous-phase CT angiogram of the chest and abdomen reveals a massive, extensive thrombus filling the apex of the left ventricle and a smaller thrombus in the left atrium. Cardiac MRI confirms severe global cardiomyopathy and subepicardial late gadolinium enhancement.
Key takeaways
Patients with severe dilated cardiomyopathy (such as HIV-associated myocarditis) are at high risk for forming extensive intracardiac thrombi due to blood stasis. Suboptimal cardiac opacification on standard CT pulmonary angiograms often reflects underlying severe low cardiac output rather than scanner or technical errors, which can completely obscure large, life-threatening ventricular thrombi.
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