Routine screening with contrast echocardiography in apical infarctions? A case report

Background:Left ventricular (LV ) thrombus detection after acute myocardial infarction (MI) im-pacts embolic event risk and anticoagulant therapy. Aim and methods: An 80-year-old male underwent routine transthoracic echocardiography the day after primary percutaneous revascularization procedure for ST-eleva-tion myocardial infarction. When ultrasound contrast was injected, regular contrast-enhancement of the left ventricle (LV ) excluded the presence of thrombus. A second echocardiogram, performed four months later, showed a hyperechoic image in the LV apex, which was confirmed after contrast injection as a thrombus. Four weeks later, a third follow-up echocardiogram appears apparently normal. However, contrast injection clearly demonstrates a new apex thrombus, in a slightly different location from the one detected previously. Results:Standard echocardiography is often inconclusive or falsely negative regarding the detection of api-cal thrombus. Conclusion: Maybe the time has come for routine contrast-echo screening in post-myocardial infarction patients with the high likelihood of thrombus, such as in cases of apical infarction, even if the standard echocardiogram appears unremarkable. (www.actabiomedica.it)