Extensive intracardiac thrombi in a pt with HF & hepatic con
Left ventricular (LV) thrombi is a complication associated with anterior ST-elevation myocardial infarction, dilated cardiomyopathies, or LV aneurysms. Right-sided intracardiac thrombi may be associated with other prothrombotic causes.

Published in the European Heart Journal Case Reports, the authors present a case of a 66-year-old man who was admitted with congestive heart failure was found to have extensive intracardiac masses on transthoracic echocardiography and cardiac magnetic resonance imaging (MRI).

This occurred in the absence of a recent myocardial infarction. During his hospital stay, he was found to have deranged liver enzymes and coagulation profile due to hepatic congestion. The patient was presumed to have intracardiac thrombi and was treated with warfarin therapy. There was complete resolution of the masses on repeat cardiac MRI after 4 weeks of treatment, confirming the diagnosis.

Learning points
• Right sided intracardiac thrombi should prompt the clinician to search for causes of hypercoagulability.

• T1- and T2-weighted sequences on cardiac magnetic resonance imaging may be useful to determine the age of intracardiac thrombi.

• Standard coagulation profiles do not measure the prothrombotic risk of patients with liver disease.

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