ABSTRACT
The use of ultrasound enhancing agents (UEA) during echocardiography helps to optimize visualization in technically difficult studies, with improved left ventricular opacification and endocardial border definition. The use of these agents may often unveil critical data that drastically alter clinical decision making. Despite the potential clinical benefits of UEA and known safety data, clinicians are still sometimes reluctant to take the time to use UEAs in unstable patients. Herein, we demonstrate a challenging case of a patient with late presentation myocardial infarction, complicated with cardiogenic shock and pseudoaneurysm formation that was not observed in non-contrast images, emblematically demonstrating the value of UEA in selected patients.
ABSTRACT
A 52-year-old man presented with altered mental status and report of prior complaint of chest pain. On electrocardiography, anterolateral ST-segment elevations with Q-waves in the septal leads were seen. Initial echocardiography images demonstrated a thickened anteroseptum. Further imaging showed the presence of a well-attached laminated apical thrombus. Contrast echocardiography images showed that the thrombus had minimal attachment to the endocardial surface. CT head subsequently showed the presence of acute stroke. The case demonstrates the additional value of contrast echocardiography in the evaluation of cardiac masses despite the certainty in the diagnosis of a thrombus.
