Thrombus and SOE ASYNC

Question 1

What is Cardiac Thrombus?

Answer 1

Coagulation of blood within the heart, appearing as echo dense mass with defined margins, commonly due to stasis or turbulent blood flow

Question 2

What is the three points of Virchow’s Triad? (In terms of thrombus risk factors)

Answer 2

1. Abnormal walls
2. Abnormal blood flow
3. Abnormal blood constituents

Question 3

What causes the thrombus risk factor of abnormal walls? 7

Answer 3

Endothelial injuries such as
1. Atherosclerosis
2. MI
3. Trauma
4. Inflammation
5. Hypertension
6. Smoking
7. Increase in cholesterol

Question 4

What causes thrombus risk factors of abnormal blood flow? 2

Answer 4

Hemodynamic changes such as
1. Stasis of blood
2. Turbulent flow

Question 5

What causes thrombus risk factors of abnormal blood constituents? 4

Answer 5

Hypercoagulability from things like
1. Prolonged bed rest
2. MI
3. A fib
4. Prosthetic valves

Question 6

What is spontaneous echo contrast also referred to as?

Answer 6

Smoke

Question 7

What is spontaneous echo contrast a precursor to?

Answer 7

Thrombus

Question 8

Spontaneous echo contrast can be sometimes be seen when?

Answer 8

With normal patients with good vis

Question 9

What are three cardiac thrombus locations?

Answer 9

1. LV thrombus
2. LA thrombus (LAA thrombus)
3. RT heart thrombus (RA, RV, PA)

Question 10

What does this image represent?

Answer 10

Spontaneous echo contrast

Question 11

What are some thrombus echo features?

Answer 11

1. Echogenic mass
2. Protruding vs Mural
3. Mobile vs sessile

Question 12

What can be said about the echogenic features of thrombus?

Answer 12

1. Older thrombus becomes more echogenic
2. Acute thrombus may be the same echogenicity of adjacent myocardium

Question 13

What can be said about the protruding and mural features of thrombus echogenicity?

Answer 13

Protruding more acute and more at risk for embolus

Question 14

What can be said about mobile echogenic thrombus?

Answer 14

More at risk for embolus

Question 15

MIs commonly involve what part of the heart?

Answer 15

APEX

Question 16

Most thrombi form near what?

Answer 16

APEX

Question 17

Blood flow velocity is lowest near what?

Answer 17

Apex

Question 18

What kind of blood will clot?

Answer 18

Stagnant blood

Question 19

Thrombus formation with MI location is where? 2

Answer 19

1. Anterior LAD (30%)
2. Inferior RCA (5%)

Question 20

When does thrombus normally happen?

Answer 20

2 weeks post MI

Question 21

In terms of embolization of thrombi, when will it normally happen?

Answer 21

1-3 months post MI

Question 22

What is the frequency of embolization of thrombi?

Answer 22

10%

Question 23

What increases the risk for embolization?4

Answer 23

1. Protruding
2. Large size
3. Mobile
4. Adjacent to hypermobile segment

Question 24

What does LV thrombus requires for viewing?

Answer 24

1. 2 views for visualization
2. High frequency probe and zoom

Question 25

What does this image represent?

Answer 25

LV thrombus

Question 26

What does these images represent?

Answer 26

Laminar vs protruding thrombus

Question 27

When is Apical LV thrombus suspected?

Answer 27

Apical thickness > septal thickness

Question 28

What should we be suspicious of, when looking at the apical LV for thrombus?

Answer 28

Akinetic Anterior/ septal walls, this indicates older thrombus

Question 29

What do we use as a contrast agent when looking for apical LV thrombus?

Answer 29

Colour doppler and a low colour scale

Question 30

What is LV contrast enhancement used for?

Answer 30

To help visualize LV where visibility is poor

Question 31

In terms of LV contrast, Microbubbles opacify what?

Answer 31

The LV cavity or myocardium

Question 32

What does this image represent?

Answer 32

LV contrast enhancement

Question 33

What does protruding thrombus indicate?

Answer 33

Recently formed thrombus

Question 34

Protruding thrombus may be less echogenic than what?

Answer 34

Laminar thrombus

Question 35

Protruding thrombus is more mobile than what?

Answer 35

Laminar thrombus

Question 36

Protruding thrombus has a higher risk for what?

Answer 36

Embolization

Question 37

What does thrombus protrudes into what?

Answer 37

LV cavity

Question 38

We use colour doppler to do what in terms of thrombus?

Answer 38

Exclude artifact

Question 39

Color doppler with a lower colour scale will no do what?

Answer 39

Fill in the area of the thrombus

Question 40

What does this image represent?

Answer 40

Using colour doppler to discern between thrombus and not

Question 41

LA thrombus requires what to form?

Answer 41

Homeostasis to form

Question 42

What is the LAA (LA appendage)?

Answer 42

Horn like projection extending anteriorly (piglet ear)

Question 43

Where is the LAA best seen?

Answer 43

In A2C and PSAX

Question 44

Where is the most common site of LA thrombus formation?

Answer 44

LAA

Question 45

What does this image represent?

Answer 45

LAA

Question 46

What does this image represent?

Answer 46

Thrombus in PSAX and TEE LAA

Question 47

What does this image represent?

Answer 47

TEE thrombus in the LAA

Question 48

What does this image represent?

Answer 48

LAA thrombus expelled into LA

Question 49

What is the best thing to use to assess thrombi?

Answer 49

TEE

Question 50

The LA is located where in both parasternal and apical windows with TEE?

Answer 50

Parasternal and apical windows

Question 51

The majority of atrial thrombi form where?

Answer 51

In the LLA which is best seen with TEE

Question 52

In the presence of A- FIB, an embolic stroke is assumed to come from where?

Answer 52

LA appendage, the other likely source is the carotid bulb

Question 53

What is the standard procedure before elective cardioversion or interventional, electrophysiology studies?

Answer 53

TEE for LA thrombus

Question 54

How common is RT heart Thrombi?

Answer 54

Rare - Occasionally with severe RV enlargement

Question 55

RT heart thrombi is most likely to come from where?

Answer 55

A DVT upstream and get trapped in the TV or RV trabeculae

Question 56

What do we call it when a DVT travels upstream and gets trapped in the TV or RV trabeculae?

Answer 56

Migratory thrombus

Question 57

Thrombus in the right heart might be attached to what?

Answer 57

Indwelling catheters or pace wires

Question 58

What does this image represent?

Answer 58

RT heart Thrombi

Question 59

What does this image represent?

Answer 59

Right atrial thrombus

Question 60

What does this image represent?

Answer 60

Pulmonary artery thrombus

Question 61

What does these images represent?

Answer 61

1. RA wall clot with PE 2. Pacer wire clot