Differential diagnosis of left ventricular mural thrombi by myocardial contrast echocardiography: a preliminary study.

Two-dimensional echocardiography has become the procedure of choice to diagnose left ventricular mural thrombi. However, small or flat thrombi may be difficult to distinguish from myocardium. The spatial distribution of the ventricular myocardial blood flow can be imaged with myocardial contrast echocardiography (MCE). The authors presumed that the absence of arterial supply to a fresh thrombus may allow MCE to distinguish between thrombus and myocardium. In the 2 cases presented here, MCE was performed with the same technique as that used for the purpose of visualization of myocardial perfusion; as a result, an apical mural thrombus, indistinct from myocardium before MCE, was visualized as a contrast defect during imaging. Conversely, myocardium that mimicked a thrombus was imaged by MCE as a contrast-opacified area. These findings suggest that MCE after reperfusion therapy is useful to distinguish mural thrombi from myocardium.