title: High-Resolution, Contrast-Enhanced Cardiac Magnetic Resonance Detects an Intracardiac Thrombus in a Fontan Patient.
abstract: A 28-year-old male with Fontan physiology presented with chest pain, elevated troponin, regional dyskinesis, and an apical echogenicity in the right-sided morphologically left ventricle (LV) on echocardiogram. Cardiac magnetic resonance (CMR) imaging was performed with a three-dimensional respiratory-navigated inversion recovery FLASH (low flip angle, spoiled gradient echo technique) sequence during slow gadolinium infusion. A hypointense lesion in the LV apex was consistent with thrombus. Gadolinium-delayed enhancement imaging demonstrated increased signal in the mid-inferior LV free wall. In this case, progressive decline in ventricular function was likely followed by an intracardiac thrombus and embolic myocardial infarction. The CMR was instrumental in characterizing the mass and identifying myocardial scar.
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA Division of Cardiology, St Christopher's Hospital for Children, Philadelphia, PA, USA catherine.avitabile@tenethealth.com.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Avitabile
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
mesh_terms: D000328:Adult; D003287:Contrast Media; D004310:Double Outlet Right Ventricle / Q000000981:diagnostic imaging* / Q000601:surgery; D005682:Gadolinium; D006343:Heart Septal Defects / Q000000981:diagnostic imaging* / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D059446:Heterotaxy Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000601:surgery
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Fontan; cardiac MRI; myocardial infarction; thrombus