Cardiac thrombi and imaging modalities (diagnosis, approach, and follow-up)

Cardiac thrombus formation is a frequent complication of numerous diseases, and its embolization can result in significant morbidity and mortality from cerebrovascular or peripheral vascular events. Early thrombus diagnosis impacts embolic event risk stratification and therapeutic decisions. Many imaging modalities have been investigated in the diagnosis of intracardiac thrombi, including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA), and cardiovascular magnetic resonance imaging (CMR). The most common and available method for diagnosing intracardiac thrombi is echocardiography; nonetheless, it is limited because intracardiac clots cannot be differentiated from cardiac masses precisely. Although TEE is semiinvasive, it has high sensitivity and specificity for finding posterior and inferior heart thromboses and is particularly efficient for evaluating clots and determining areas of blood stasis (smoke) in the left atrium. By contrast, TTE is noninvasive and can be used for the visualization of thrombi in the ventricles. Nevertheless, it provides limited views of the left ventricular apex and the distal portion of the ascending aorta. CCTA and CMR are well-established alternatives for detecting intracardiac thrombi. These methods require more time and greater resources but may provide improved detection of cardiac thrombi.