Missed large left ventricular thrombus. Failure of two-dimensional echocardiography in one case.

In the case reported, two-dimensional echocardiographic study of a man six weeks after he sustained an extensive transmural anterolateral infarct failed to show evidence of an intraventricular thrombus. Ten days later the patient suddenly died. Autopsy findings included a large fibrin clot, weighing 50 gm, in the left ventricle. Two-dimensional echocardiography is a very sensitive method of defining aneurysm in the apex of the heart and identifying and locating ventricular thrombi usually associated with aneurysm. I consider the false-negative finding in this case to be a rare exception.