Improved echocardiographic delineation of left ventricular thrombus with the use of intravenous second-generation contrast image enhancement

Transthoracic echocardiography is the most widely used diagnostic test for left ventricular (LV) thrombus, which must be distinguished from other intraventricular structures and image artifacts. To determine whether second- generation intravenous echocardiographic contrast agents provide better delineation of LV thrombus, we reviewed the results of 2-dimensional echocardiographic studies that were performed in 409 patients over a 1-year period to detect LV thrombus. Studies of 190 (46%) patients were interpreted as nondiagnostic for this purpose, of which 48 patients underwent an additional study after intravenous injection of 0.5 to 2 mL of human albumin microspheres within 1 to 4 days. In 43 (90%) of these 48 patients the contrast-enhanced study was definitive and diagnostic for either the presence or absence of an LV thrombus (P < .0001). Of the initial total of 409 patients, 81 had been studied at the bedside in intensive care units. The bedside studies were nondiagnostic for LV thrombus in 51 (63%) of these 81 patients. Of these 51 patients, 14 underwent additional imaging with contrast enhancement, and the contrast-enhanced images became diagnostic (P = .004) in 11 (79%) of them. Thus intravenous contrast image enhancement improves the diagnostic yield of echocardiography in patients in whom initial images are nondiagnostic for LV thrombus.