Left Atrium/Left Atrial Appendage: most atrial thrombi occur in the left atrium/left atrial appendage
Right Atrium: thrombi rarely occur in the right atrium
When present, they are usually associated with venous thrombus that is extending into the RA from either the inferior vena cava (IVC) or superior vena cava (SVC)
Right atrial thombus has been reported in the setting of end-stage liver disease (undergoing orthotopic liver transplantation)
Left Ventricle: left ventricular thrombi usually develop in the left ventricular apex
Right Ventricle: thrombi rarely occur in the right ventricle
When present, they are usually associated with venous thrombus that is extending into the RA from either the inferior vena cava (IVC) or superior vena cava (SVC)
Right ventricular thombus has been reported in the setting of end-stage liver disease (undergoing orthotopic liver transplantation)
Acute Myocardial Infarction (see Coronary Artery Disease, [[Coronary Artery Disease]]): due to hypokinesis/akinesis of a given wall
Spontaneous echocardiographic contrast (“smoke” appearance) is considered a prethrombotic condition and is associated with an increased risk of thromboembolic events [MEDLINE]
Trans-thoracic echocardiogram is considered to have higher sensitivity than trans-esophageal echocardiogram for the detection of left ventricular thrombi, as trans-esophageal echocardiogram incompletely visualizes the apex: the accuracy of trans-thoracic echocardiogram is further increased by using color Doppler and/or intravenous contrast (Definity)
Trans-thoracic echocardiogram is considered to have lower sensitivity than trans-esophageal echocardiogram for the detection of left atrial/left atrial appendage thrombi
Transesophageal Echocardiogram: may be used in some cases
Echocardiographic Features Which Predict an Increased Risk of Embolization
Larger Thrombus Size
Thrombi Which are Mobile and Protrude into the LV Chamber: particularly in older patients
Risk factors for intracardiac thrombus in patients with ischaemic cerebrovascular events. J. Neurol. Neurosurg. Psychiatry75,1421–1425 (2004) [MEDLINE]
