Anticoagulation with heparin resulted in rapid resolution of a 1.5 cm left ventricular apical thrombus within 3 days in a patient with suspected left ventricular noncompaction cardiomyopathy.
Case Report (n=1)
No
Serial imaging is crucial in left ventricular noncompaction cardiomyopathy to differentiate between a true tumor and a thrombus exhibiting pseudo-enhancement on contrast echocardiography.
Left ventricular noncompaction cardiomyopathy (LVNC) is associated with thromboembolic complications and can complicate intracardiac mass interpretation. A 58-year-old man with prior left ventricular (LV) apical thrombus presented with abdominal pain and weight loss. Contrast-enhanced transthoracic echocardiogram (TTE) showed severe LV dysfunction (left ventricular ejection fraction (LVEF) 15-20%) and a 1.5 cm mobile apical mass with apparent central contrast uptake, raising concern for a tumor in the setting of suspected prostate malignancy. Heparin was initiated. On day 3, the mass had resolved, and repeat echocardiography demonstrated prominent apical trabeculations and a low-flow apex with findings suggestive of LVNC, indicating that the perceived "vascularity" likely reflected pseudo-enhancement. This case emphasizes serial imaging and multimodality assessment when uncertainty persists.
Elhussain et al. (Fri,) conducted a case report in 58-year-old man with left ventricular noncompaction cardiomyopathy phenotype, severe left ventricular systolic dysfunction (LVEF 15-20%), and recurrent left ventricular apical thrombus (n=1). Intravenous heparin followed by rivaroxaban 20 mg daily was evaluated on Resolution of left ventricular apical mass (thrombus) on echocardiography after anticoagulation. Anticoagulation with heparin resulted in rapid resolution of a 1.5 cm left ventricular apical thrombus within 3 days in a patient with suspected left ventricular noncompaction cardiomyopathy.