Radiologic Detection of a Calcified Thrombus Within the Left Ventricle

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Abstract
Roentgen criteria for the recognition and localization of cardiac calcification have been well established (1, 2). Detection of calcific deposits within the annulus fibrosus, valves, coronary arteries, myocardium, and pericardium has frequently been described. Radiologic antemortem observation of left atrial calcification, however, was rarely reported until recent years (3, 4, 5). Roentgen diagnosis of a calcined thrombus within the left ventricle is a rarity. The following case report emphasizes the importance of careful fluoroscopy in the recognition of this condition. Case Report A 41-year-old female was hospitalized in October 1952 for the surgical relief of mitral stenosis. Pre-operative fluoroscopic examination presented immediate and obvious evidence of two well denned calcium masses within the cardiac silhouette (Figs. 1 and 2). On careful observation it was noted that these two calcific “islands” displayed independent motion, approaching each other during ventricular systole and separating during diastole (Fig. 3). A normal sinus rhythm was present, with a cardiac rate of 70/min., so that motion of the calcifications could be correlated with pulse and heart sounds. The uppermost calcific mass displayed typical elliptical oscillatory motions, and its location left little doubt that it represented plaque-like calcification of the mitral valve. The large “island” of calcium in the lowermost portion of the cardiac silhouette was deeply located within the heart in all angles of rotation. Moreover, this mass was clearly situated within the territory of the left ventricle and assumed considerable dimensions in all observed positions. For these reasons, a preoperative diagnosis of calcified left ventricular thrombus was made in a case of mitral stenosis. At surgery, the pericardium was found to be non-adherent, and a large, mound-like elevation could be seen and felt over the posterior portion of the left ventricle, where contraction was limited. The overlying myocardium was not grossly discolored. Digital exploration through the left atrial appendage revealed extensive calcification of a stenotic mitral valve, markedly involving the septal leaflet. Following commissurotomy, the exploring intra-atrial finger was passed into the left ventricle, where the posterior chordae tendinae seemed to be enmeshed in a firm mass consistent with thrombus. Summary Radiologic diagnosis of an unusual case of calcified thrombus within the left ventricle is reported. Recognition of a deep location of the thrombus within the territory of the left ventricle and changes in its position induced by ventricular motion are stressed as important features in the diagnosis.

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