Thrombus, tumor or vegetation?

Thrombus, tumor or vegetation? This question is often faced by the echocardiographer while evaluating a mass detected on the heart valves or cardiac chambers. Usual method is to take it in the clinical context. There could also be non-infective vegetations of marantic endocarditis which are almost impossible to differentiate from infective vegetations. Marantic vegetations can be suspected in the presence of small and multiple vegetations changing from one examination to another, without associated abscess or valve destruction [1]. It may be noted that echocardiography is neither 100% specific nor 100% sensitive for the diagnosis of infective endocarditis. Vegetations in general are irregular in shape, mobile and attached to a valve. But there could be vegetations attached to the myocardium in locations of jet lesions. Tumors of the heart are considered more likely in certain locations like a left atrial myxoma or a ventricular rhabdomyoma in an infant. But left atrium is also the commonest site for a large thrombus, especially in the presence of mitral stenosis. Thrombus will not have a stalk unlike a left atrial myxoma which often has a stalk, though sessile myxomas are also there. Thrombus responds to thrombolytic therapy, with a significant risk of major embolism in the process! But a giant organized thrombus responds poorly to thrombolysis. In case of left ventricular mass, associated regional or global hypokinesia may favor the diagnosis of thrombus. Associated systemic...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs