Routine Screening with Contrast Echocardiography in Apical Infarctions? A case report

Routine Screening with Contrast Echocardiography in Apical Infarctions? A case report


  • Carmine Siniscalchi Parma University Hospital
  • Nicola Gaibazzi Parma University Hospital


Contrast Echocardiography, Thrombus, Apical Infarctions


A a 80-year-old male underwent routine transthoracic echocardiography the day after primary percutaneous revascularization procedure for ST-elevation 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. Standard echocardiography is often inconclusive or falsely negative regarding the detection of apical thrombus. 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.


Vaitkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol, 1993; 22:1004-1009

Stratton JR, Resnick AD. Increased embolic risk in patients with left ventricular thrombi. Circulation, 1987; 75:1004-1011

Haugland JM, Asinger RW, Mikell FL, Elsperger J, Hodges M. Embolic potential of left ventricular thrombi detected by two-dimensional echocardiography. Circulation, 1984; 70: 588-598

Olszewski R, Timperley J, Szmigielski C, Monaghan M, Nihoyannopoulos P, Senior R, Becher H. The clinical applications of contrast echocardiography. Eur J Echocardiogr 2007;8:S13–S23

Weinsaft JW, Kim RJ, Ross M, et al. Contrastenhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus. J Am Coll Cardiol Img 2009;2:969–79

Weinsaft JW, Kim HW, Crowley AL, et al. LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. J Am Coll Cardiol Img 2011;4:702–12.

Lehman EP, Cowper PA, Randolph TC, Kosinski AS, Lopes RD, Douglas PS. Usefulness and Cost-Effectiveness of Universal Echocardiographic Contrast to Detect Left Ventricular Thrombus in Patients with Heart Failure and Reduced Ejection Fraction. Am J Cardiol. 2018;122:121-128

Kitzman DW, Goldman ME, Gillam LD, Cohen JL, Auigemma GP, Gottdiener JS. Efficacy and safety of the novel ultrasound contrast agent perflutren (definity) in patients with suboptimal baseline left ventricular echocardiographic images. Am J Cardiol 2000;86:669–674

Mansencal N, Nasr IA, Pillière R, Farcot JC, Joseph T, Lacombe P, Dubourg O. Usefulness of contrast echocardiography for assessment of left ventricular thrombus after acute myocardial infarction. Am J Cardiol 2007;99:1667–1670

Porter TR, Abdelmoneim S, Belcik JT, McCulloch ML, Mulvagh SL, Olson JJ, Porcelli C, Tsutsui JM, Wei K. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr 2014;27:797–810

Crouse LJ, Cheirif J, Hanly DE, Kisslo JA, Labovitz AJ, Raichlen JS, Schutz RW, Shah PM, Smith MD. Opacification and border delineation improvement in patients with suboptimal endocardial border definition in routine echocardiography: results of the Phase III Albunex Multicenter Trial. J Am Coll Cardiol 1993;22:1494–1500




How to Cite

Siniscalchi C, Gaibazzi N. Routine Screening with Contrast Echocardiography in Apical Infarctions? A case report. Acta Biomed [Internet]. 2021 Apr. 30 [cited 2024 Jul. 20];92(S1):e2021053. Available from: