Overview
Mural thrombi in the heart involve clot formation within the cardiac walls, often associated with significant morbidity and mortality due to embolization and hemodynamic compromise. These thrombi can occur in various cardiac chambers, including the right ventricle and aorta, each presenting unique clinical challenges 123.Diagnosis
Transthoracic echocardiography (TTE): Primary imaging modality for initial detection 1.
Contrast-enhanced echocardiography: Enhances visualization and characterization of thrombus 1.
Cardiac magnetic resonance imaging (MRI): Provides detailed anatomical information and can differentiate thrombus from other masses 1.
Cross-sectional echocardiography: Useful for diagnosing infected thrombi, especially in complex cases like left ventricular aneurysms 3.Management
Anticoagulation: Initial treatment option, though outcomes may be suboptimal compared to more aggressive therapies 1.
Thrombolysis: Shown to have better survival outcomes than anticoagulation alone 1.
Catheter-based procedures: Include thrombectomy, offering minimally invasive alternatives 1.
Surgical embolectomy: Effective in selected cases, particularly when other methods are not feasible or have failed 1.Special Populations
Young women on steroidal medications and heavy smokers: Susceptible to aortic mural thrombi, possibly representing a distinct clinical entity beyond premature arteriosclerosis 2.Key Recommendations
Use echocardiography and MRI for definitive diagnosis of mural thrombi (Evidence: Moderate 13).
Consider thrombolysis or surgical embolectomy over anticoagulation alone for improved survival outcomes (Evidence: Moderate 1).
Evaluate young women on steroidal medications and heavy smokers for unique risk factors related to aortic mural thrombi (Evidence: Weak 2).References
1 Feldman JM, Frishman WH, Aronow WS. Review of the Etiology, Diagnosis, Classification, and Therapy of Right Heart Thrombi. Cardiology in review 2025. link
2 Perler BA, Kadir S, Williams GM. Aortic mural thrombus in young women: premature arteriosclerosis or separate clinical entity?. Surgery 1991. link
3 Schofield PM, Rahman AN, Ellis ME, Dunbar EM, Bray CL, Brooks N. Infection of cardiac mural thrombus associated with left ventricular aneurysm. European heart journal 1986. link