8 thoughts on “Clinical Quiz— Seelan

  1. Discussion:-
    Rani’s case of “Broken Heart Syndrome” prompted me to put this case up.
    Patient was referred to us for CT of abdomen with a history of abdominal pain. Past history includes Lymphoma in remission, multiple coronary events & TIA.

    The CT showed only a simple cyst in the right lobe of liver, proved by ultrasound & nothing else significant within the abdomen & pelvis.
    In radiology, we were taught to ‘always look at the corners & edges of the film’.
    In this case, there is a filling defect within the left ventricle & another tiny one in the right ventricle. A linier metal seen in the right ventricle is a Pacemaker.

    DD of Left Ventricular mass :- Thrombus, Fibroma, Myxoma & vegetation.
    In this case,Past history plays an important part in the differentiation. Thrombus can form in the LV in patients with coronary events , LV aneurysm, cardiomyopathy (including Takotsubo broken heart) Myocarditis etc where there is cardiac wall motion abnormality.
    This patient also has a history of TIA.
    The above are in favour of the filling defect in the heart to be an organised Thrombus.

    Echo cardiography is an important investigation. Contrast MRI is used to identify any vascularity (as in tumours)

    Diagnosis : Organised Thrombus – an incidental finding but very helpful !

    Thank you for participating.

    Seelan

    Like

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