Revealing the etiology of a left ventricular mass using cardiac magnetic resonance

A 59-year-old female with history of breast and ovarian CA was being evaluated because of an incidentally noted left ventricular mass on a routine follow-up breast MRI. Transthoracic and transesophageal echocardiograms detected a large pedunculated LV mass (6.4cm x 2.4cm) attached to the apex. A cardiac MRI was done to better characterize the mass. Spin echo weighted T1 and T2 sequences demonstrated a large cylindrical mass attached to the apex, nearly iso-intense with the myocardium that does not thicken with systole. Inversion recovery imaging sequence timed to null thrombus confirmed the mass to be a thrombus. Delayed enhancement imaging showed an antero-lateral-apical scar consistent with distal left anterior descending (LAD) artery infarct of the anterior left ventricular wall. The patient had no history of a prior MI and had no previous ischemic cardiac work up. Herein, we describe a rare case of an exceptionally large intracavitary thrombus overlying an apical infarct detected only by cardiac MRI in a patient with a probable hypercoagulable state from ovarian CA.