CTICasesLeft Ventricular Apical Thrombus (Post-Infarct)
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Imaging findings
A patient with cholangiocarcinoma showed thinning of the left ventricular apical wall and septum, indicative of a left ventricular infarct. Delayed phase CT (pancreas protocol) clearly demonstrated a persistent filling defect consistent with an apical thrombus, which was missed on a subsequent echocardiogram.
Key takeaways
CT, especially with delayed phases, can be highly sensitive for detecting left ventricular apical thrombi post-infarct, often surpassing the sensitivity of echocardiography, particularly for apical lesions which are a known blind spot for echo.
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