0:00

Okay, so the next case is an interesting example

0:04

and this is more a general case

0:06

and a little less specific to coronary disease.

0:09

You certainly see that there's more than the their share

0:12

of coronary atherosclerosis on this case,

0:15

but I just wanted to point out

0:16

that in the setting a large left atrium

0:18

or ventricle, you want to think about the risk for thrombus.

0:21

In fact, I would call this bi atrial enlargement.

0:23

The left atrium is certainly large.

0:25

You would measure it at the level

0:26

that inferior pulmonary veins, anything bigger than 3.8

0:30

to four centimeters is enlarged.

0:31

And the left, um, atrium is just as big as the right atrium.

0:34

So bi atrial enlargement. However, um, this is my non-con.

0:39

This is my contrast. Uh, here's just a coronal view.

0:42

Uh, on the first pass, early profusion,

0:45

and this is a late image

0:48

and we can see is that there's thrombus

0:50

that does not resolve.

0:51

You can see though the size of this thrombus

0:53

that we see on the arterial phase, um, is not quite as big

0:57

as on the delayed phase.

0:58

And that's 'cause the edge of that hypo enhancement

1:00

and filling defect is mixing artifact

1:03

and that's why it's a little ill-defined.

1:05

But when you grab a delayed image, you can clearly see

1:07

that the tip of the appendage does not fill in.

1:09

So this is a left atrial appendage thrombus

1:12

and, um, you'd wanna alert the referring physician

1:14

because if the patient's not on blood thinners,

1:16

or even if they are, this can become a cerebral infarct

1:20

or myocardial infarct.

1:21

Same holds true in the ventricle.

1:23

It's just that there's really mixing artifact in the

1:26

ventricle because it's so dynamic.

1:27

Whereas in a patient like this with atrial fibrillation

1:30

and the left atrium is just quivering much more likely

1:32

to get the stasis or the VCAL triad type of situation

1:36

where you can have thrombus formation in the ventricle.

1:38

We've seen the examples all revolve around infarcts.

1:41

So there's a thinning of the wall in either an kinesis

1:44

or a hypokinesis that would happen elsewhere.

1:46

I don't see that in this case,

1:47

but I just wanted to point out the value of a delayed image

1:50

and looking at pretest wrist for thrombus,

1:53

even if you were the first to know it, you should think

1:54

through that, um, implication of a large left atrium

1:57

or a ventricular aneurysm.