This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thuny, F. Articles by Habib, G. Search for Related Content PubMed PubMed Citation Articles by Thuny, F. Articles by Habib, G. Related Collections Arterial thrombosis Echocardiography

(Circulation. 2006;113:e932-e933.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Massive Biventricular Thrombosis as a Consequence of Myocarditis

Findings From 2-Dimensional and Real-Time 3-Dimensional Echocardiography

Franck Thuny, MD; Jean-François Avierinos, MD; Bertrand Jop, MD; Laurence Tafanelli, MD; Sébastien Renard, MD; Alberto Riberi, MD; Dominique Métras, MD; Gilbert Habib, MD

From the Departments of Cardiology (F.T., J.-F.A., B.J., L.T., S.R., G.H.) and Cardiothoracic Surgery (A.R., D.M.), Centre Hospitalo-Universitaire de la Timone, Marseille, France.

Correspondence to Dr Franck Thuny, Hôpital de la Timone, Département de Cardiologie, Boulevard Jean Moulin, 13005 Marseille, France. E-mail franck.thuny{at}wanadoo.fr

A 43-year-old man with medical history of gastroenteritis 2 weeks previously was referred to our intensive care unit for acute chest pain. At admission, the ECG showed negative T waves in V1, V2, V3, and V4 leads, and his troponin serum level was 0.6 ng/mL. His C-reactive protein level was elevated at 70 mg/L, and the serum blood count showed hyperleukocytosis with hyperlymphocytosis and thrombocytosis. Two-dimensional transthoracic echocardiogram revealed a dilated and hypokinetic left ventricle (LV) and a biventricular thrombosis (Figure 1). A dramatic and mobile apical thrombus appeared in the LV cavity; a smaller one near to the septo-basal wall was better assessed by real-time, 3-dimensional transthoracic echocardiogram (Figure 2, Movie I, and Movie II). Another thrombus was observed in the apex of the right ventricle (Figure 2, Movie III). Abdominal computed tomography scan revealed a massive splenic infarction that explained the thrombocytosis. The coronary angiogram was normal. Facing a large and mobile LV apical thrombus and a high risk of new embolization, we performed a total thrombectomy in an urgent setting through an aortotomy and both a left and right atriotomy. Despite an early postoperative recurrence of a small LV thrombus, the outcome was favorable, with disappearance of this thrombus after anticoagulation therapy, spontaneous resolution of the inflammatory syndrome, and an improvement in LV function. The presumptive final diagnosis was myocarditis complicated by biventricular thrombosis.

View larger version (17K): [in this window] [in a new window]   Figure 1. Two-dimensional transthoracic echocardiogram in apical 4-chamber (A and B) and 3-chamber (C) views showing a dramatic biventricular thrombosis, with 2 thrombi in the left ventricular cavity (A) and an apical thrombus in the right ventricular apex (B).

View larger version (41K): [in this window] [in a new window]   Figure 2. Real-time 3-dimensional echocardiogram using a 60° x 30° pyramid of data showing in parasternal long-axis view the 2 left ventricular thrombi, especially the one near to the septo-basal wall and the anterior leaflet of the mitral valve (A); in parasternal short-axis view the large and mobile apical left ventricular thrombus extending to the level of the papillary muscles (B); and in apical 4-chamber views the biventricular thrombosis from right and left ventricles (C and D).

	Acknowledgments

 
Disclosures

None.

	Footnotes

 
The online-only Data supplement, which contains movies, can be found at http://circ.ahajournals.org/cgi/content/full/113/25/e932/DC1.

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thuny, F. Articles by Habib, G. Search for Related Content PubMed PubMed Citation Articles by Thuny, F. Articles by Habib, G. Related Collections Arterial thrombosis Echocardiography