Cardiac CT in the diagnosis and follow-up of left ventricular thrombus: a case report.

Abstract

Left ventricular (LV) thrombus is a serious complication of ischemic heart disease, particularly following myocardial infarction, and is associated with an increased risk of systemic embolization and adverse outcomes. While transthoracic echocardiography (TTE) is commonly used for thrombus detection, its sensitivity may be limited in certain clinical scenarios. We present the case of a 64-year-old male with a history of type 2 diabetes mellitus, hypertension, hyperlipidemia, and chronic kidney disease, who developed recurrent chest pain and was found to have multi-vessel coronary artery disease. Cardiac computed tomography angiography (CCTA) performed in March 2024 revealed a right-dominant coronary system with severe subtotal long non-calcified distal left anterior descending (LAD) stenosis, moderate mid-LAD and ramus intermedius stenosis, and preserved patency of the circumflex and right coronary arteries. Notably, the CTA demonstrated apical thinning and aneurysm of the left ventricle with a clearly visualized LV apical thrombus, a finding not definitively identified on TTE, which showed preserved ejection fraction but apical akinesis. The patient was managed with aggressive medical therapy, including dual antiplatelet agents, high-intensity statin, PCSK9 inhibitor, antihypertensive therapy, and underwent percutaneous coronary intervention of LAD. Serial laboratory studies showed well-controlled diabetes and lipid levels, and stable renal function. On follow-up CTA in April 2025, the previously visualized LV apical thrombus had resolved, with persistent apical thinning and aneurysm consistent with prior myocardial infarction. The distal LAD stent remained patent, and the patient remained clinically stable without embolic or heart failure events. This case highlights the utility of cardiac CTA not only in the comprehensive evaluation of coronary anatomy and plaque burden but also in the diagnosis and longitudinal monitoring of LV thrombus, particularly when echocardiographic findings are inconclusive. Cardiac CTA should be considered as a valuable adjunctive imaging modality in the management of complex ischemic cardiomyopathy complicated by LV thrombus.