CTICasesContained Left Ventricular Rupture with Large Thrombus
▶ Watch on YouTube — age-restricted, cannot embed here
Imaging findings
Chest x-ray shows cardiomegaly, signs of mild interstitial edema and vascular congestion, abnormal contour of the right heart border, and posterior pericardial effusions. HASTE images demonstrate pleural effusions, significant left ventricular dilation, and circumferential thickening consistent with hypertension-related hypertrophy. Abnormal appearance of the inferior cardiac chamber with increased signal in the inferior wall is noted. Cine imaging reveals significantly decreased global contractility (hypokinesis) with additional regional dyskinesis and a diminutive myocardium over the inferior wall. Post-contrast and PSIR images depict low signal intensity tissue adjacent to the left ventricular myocardium, characteristic of a large thrombus containing a contained rupture of the left ventricle at the inferior wall, accompanied by reactive pericardial thickening, enhancement, and effusion, with transmural enhancement in the RCA territory.
Key takeaways
A contained left ventricular rupture can be masked by a large thrombus. CMR is crucial for characterizing myocardial wall integrity, thrombus, and pericardial involvement. Look for regional wall motion abnormalities, myocardial thinning, and abnormal signal characteristics (e.g., low signal on PSIR for thrombus, transmural enhancement for infarction/rupture). Progressive CHF symptoms in a patient with a prior MI (even if unrecognized) should prompt suspicion for structural complications.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Miliary Tuberculosis with Ghon ComplexInfection
- Pulmonary Arterial Hypertension (Group 1) in Elderly PatientVascular
- Coiled Ascending Aortic Pseudoaneurysm Post-Dissection RepairVascular
- Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm Post-Mitral Valve ReplacementVascular
- Infected Ascending Aortic Graft (Culture-Negative)Infection
- Missed Type A Aortic Dissection with Giant Ascending Aortic AneurysmVascular
- Cystic Lung Disease secondary to Crack Cocaine Use (Crack Lung)Exposure
- Extranodal Marginal Zone Lymphoma with Extensive Pulmonary InvolvementNeoplastic
See all cases from May 15, 2015 →
Related Vascular cases
- Type A Aortic Dissection with Pulmonary Artery Blood Sheath
- Intercostal Artery Pseudoaneurysm secondary to Severe Scoliosis
- Chronic Thromboembolic Pulmonary Hypertension Treated with Pulmonary Thromboendarterectomy
- Spontaneous Left Anterior Descending Artery (LAD) Dissection
- Pulmonary Artery Compression of Right Middle Lobe Bronchus in Eisenmenger Syndrome
- Post-Myocardial Infarction Right Ventricular Rupture with VSD and Hemopericardium