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Previous Volume 348:2469 June 12, 2003 Number 24 Next

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To the Editor: Lee and Atwood (March 6 issue)¹ provide an example of a calcified left ventricular aneurysm visualized by computed tomography (CT). On closer inspection, the pattern of calcifications in the apical region of the left ventricle gives reason to suspect the presence of a partly calcified ventricular thrombus as well. The arrow in their image actually points at a smaller calcified area that is clearly disparate from the thin, crescent-shaped calcification of the aneurysm itself and may be part of an apical thrombus. In addition, there are two smaller and less well-defined regions of higher attenuation close to either end of this structure, again raising the suspicion of small calcifications (which may appear less sharply delineated because of motion artifacts). Such a pattern is typical of a partly calcified thrombus (Figure 1); thus, this diagnosis must be taken into account, and further imaging may be warranted. The findings might have been clearer if CT technology with higher temporal resolution had been used.

View larger version (57K): [in this window] [in a new window]   Figure 1. Calcifications Visualized by Electron-Beam CT in the Apical Region of the Left Ventricle (Panel A, Arrows), Raising the Suspicion of a Partly Calcified Thrombus, and an Echocardiograph Showing the Thrombus in a Modified Two-Chamber View (Panel B, Arrows).

 

Stephan Achenbach, M.D.
Massachusetts General Hospital
Boston, MA 02114
sachenbach{at}cvimager.mgh.harvard.edu

Dieter Ropers, M.D.
Werner G. Daniel, M.D.
University of Erlangen
D-91054 Erlangen, Germany

References

1. Lee BK, Atwood JE. Calcified left ventricular aneurysm. N Engl J Med 2003;348:918-918. [Free Full Text]

Achenbach et al. also point out that there are smaller calcified areas that are disparate from the calcified left ventricular aneurysm. We agree that this calcification may be part of an apical thrombus. A CT scan with intravenous contrast medium would probably have been better at delineating a thrombus, but intravenous contrast medium could not be used, since the patient had renal insufficiency. Echocardiography did not show an apical thrombus. However, an apical thrombus could have been obscured by the surrounding calcification.

Byron K. Lee, M.D.
University of California, San Francisco
San Francisco, CA 94143
leeb{at}medicine.ucsf.edu

J. Edwin Atwood, M.D.
Walter Reed Army Medical Center
Washington, DC 20307

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This article has been cited by other articles:

• Harrison-Gomez, C., Harrison-Ragle, A., Arceo-Navarro, A. (2007). A Ring in the Heart Calcified Left Ventricular Aneurysm. Circulation 115: e376-e377 [Full Text]