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Forty-five patients (35 men, 10 women) undergoing carotid surgery had Indium-111 platelet scintigraphy as part of their preoperative work-up. Imaging was performed within three hours after injection of the Indium-111. A second series of views was obtained 24 hours later and repeated at 24 hour intervals for two days. Of 54 scintigrams, 22 were positive and 32 negative. Positive results were defined as a twofold or more increase in local activity on a visualized carotid after 24 hours. The sensitivity of the method was 41%, intraoperatively, and the specificity, 100%. The low sensitivity places this method behind sonography and duplex-scanning for screening patients for surgery. We believe that indications for platelet scintigraphy are limited to: 1. Repeated transient ischemic attacks in the same territory with minimal lesions on arteriography and non-homogeneous plaque on duplex scan; 2. Symptomatic patients being treated medically as a possible argument for surgery; 3. Determining therapeutic policy for patients having experienced a transient ischemic attack with a coexisting intracardiac thrombus.

Thirty-eight patients with conditions predisposing to intracardiac thrombus have been studied by computed tomography and cross-sectional echocardiography. Computed tomography identified 22 cases of intracardiac thrombus (13 left ventricular, eight left atrial and one right atrial). Cross-sectional echocardiography identified five of these left ventricular thrombi and the right atrial thrombus, but none of the left atrial thrombi. In addition, measurements of thrombus density on computed tomography identified a significant difference (p less than 0.02) between the density of a new compared with an organized thrombus.

Precordial echocardiography has revolutionized the examination of the heart for tumors and thrombus. Most benign and malignant tumors, as well as intracardiac thrombus of all etiologies, have been described in the two-dimensional (2-D) echocardiographic literature. As with any technology, there are limitations and improvements in technology which define and continuously change the diagnostic capabilities. Limitations of transthoracic echocardiography (TTE) include an inability consistently to image targets in the far field, small embedded or mural masses, and certain structures, including the atrial appendages and pulmonary veins. Pedunculated masses, such as cavitary myxomas or thrombus, are usually accurately diagnosed by precordial echocardiography. However, these easily diagnosed masses may appear atypical and require further characterization in order to establish a proper diagnosis or determine pertinent associations.

Fifty-four percent of left atrial appendages have two lobes. The number ranges from one to four lobes. We describe three patients with accessory lobes of the left atrial appendage studied with multiplanar transesophageal echocardiography (TEE). In one patient there was evidence of thrombi in the accessory lobe.

We describe the case of a patient who developed a thrombus on the transseptal sheath in the right atrium before transseptal puncture for circumferential pulmonary vein isolation for paroxysmal atrial fibrillation treatment. The use of intracardiac echocardiography allowed to its identification and probably prevented the patient from suffering a serious thromboembolic complication.

The probability of right heart thrombus co-existence should be considered in patients with antiphospholipid syndrome (APS) who have pulmonary and cardiac symptoms. The prevention and management of intracardiac thrombotic events include early use of anticoagulation therapy.

[No abstract available]

We present a rare image documenting direct transit of a thrombus originating from the venous circulation and passing through a patent foramen ovale linked to a malpositioned cannula in the setting of temporary mechanical circulatory assistance in a young patient who underwent a peripheral extra corporeal membrane oxygenation as a circulatory support.

Few prospective studies support the use of anticoagulation during the acute phase of ischemic stroke, though observational data suggest a role in certain populations. Depending on the mechanism of stroke, systemic anticoagulation may prevent recurrent cerebral infarction, but concomitantly carries a risk of hemorrhagic transformation. In this article, we describe a case where anticoagulation shows promise for ischemic stroke and review the evidence that has discredited its use in some circumstances while showing its potential in others.

Because of its capacity to form a deposit on thrombus fibrin, 99mTc-mac-roaggregated albumin can be used to detect intracardiac thrombus by routine imaging. The authors report a case of right ventricular thrombus diagnosed antemortem on a routine lung study in a patient with an intracardiac hyperalimentation catheter in place.

A patient with a consumptive coagulopathy of 11 months' duration that was due to a large left atrial mural thrombus is described. Bleeding occurred only with the hemostatic challenge of surgery. Heparin was used perioperatively to facilitate two surgical procedures. The coagulopathy was reversed by removal of the thrombus.

Behcet’s disease (BD) is recognized as a systemic vasculitis involving both arteries and veins of any size and characterized by recurrent oral aphthous ulcers, genital ulcers, and uveitis and skin lesions. The mean age of onset is in the fourth decade.

Right atrioventricular thrombus was diagnosed by echocardiography in a 14-year-old boy. Thrombus was reached through the right ventricle to the pulmonary artery and it was caused to tricuspit valve insufficiency. Surgical thrombectomy was performed and, he was treated with oral anticoagulation in postoperative period.