Left ventricle pedunculated thrombi risks and outcomes: a case report and literature review

Ali, Ahmed Ali; Sakr, Eman Elsayed

doi:10.1590/1677-5449.202301242

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Brasil

Jornal Vascular Brasileiro

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Brasil

Español English

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Case Report • J. Vasc. Bras. 23 • 2024 • https://doi.org/10.1590/1677-5449.202301242 copy

Left ventricle pedunculated thrombi risks and outcomes: a case report and literature review

Riscos e desfechos de trombos pedunculados no ventrículo esquerdo: relato de caso e revisão da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

A 42-year-old male with ischemic cardiomyopathy presented with acute bilateral femoral artery embolization. After management with embolectomy and fasciotomy in both femoral arteries, transthoracic echocardiography revealed two pedunculated highly mobile left ventricle (LV) thrombi. Given the procedural risk, anticoagulation therapy was recommended over surgery. However, the bleeding risk impeded the continuation of anticoagulation, which increased the thrombus size. Multiorgan failure and disseminated intravascular coagulopathy followed and the patient died. We also systematically reviewed the PubMed and Scopus databases for pedunculated LV thrombi cases and retrieved 74 and 63 reports respectively. Of these, 37 relevant reports (45 cases) plus 11 reports from the manual search were included for data extraction, a total of 56 cases besides our case. Based on the etiologies and risks, LV thrombi are predictable and preventable, especially after ischemic events. A clear diagnostic algorithm and vigilant follow-up are needed as well as multidisciplinary management once a diagnosis is confirmed.

Keywords:
left ventricle; myocardial infarction; thrombosis; emboli; risks; outcomes

Author/ year	Age (year)	Gender	Risk factors	Presentation	ECG	Extracardiac emboli site	Cause	Management	Outcome/ complications	Evidence level
Kumar et al., 2016⁹9 Kumar USD, Shetty SP, Sujay KR, Wali M. Left ventricular mass: a tumor or a thrombus diagnostic dilemma. Ann Card Anaesth. 2016;19(4):728-32. http://doi.org/10.4103/0971-9784.191551. PMid:27716707. http://doi.org/10.4103/0971-9784.191551...	44	Male	Smoking	TIA (upper limb weakness)	old anterolateral MI (t wave inversion and downward ST sloping v1-4)	brain	Old anterolateral STEMI	surgical removal	Recovery and discharge.	4
Grewal et al., 2020¹⁰10 Grewal HK, Bansal M, Garg A, Kasliwal RR, Bhan A, Gautam D. Left ventricular thrombus and cardioembolic stroke in a patient with ulcerative colitis: a case report. Saudi J Med Med Sci. 2021;9(1):67-70. http://doi.org/10.4103/sjmms.sjmms_525_19. PMid:33519347. http://doi.org/10.4103/sjmms.sjmms_525_1...	23	Female	ulcerative colitis (diagnosed 2-3 weeks before presentation)	Stroke (sudden weakness on the right side with aphasia; left MCA infarction) followed by episodes of TIA despite anticoagulation therapy	Normal	brain, MCA	Ulcerative colitis	Surgical removal	Recovery and discharge.	4
Garg et al., 2021¹¹11 Garg A, Hakeem H, Chennu G, et al. Left ventricular mural thrombi with multisystem thrombosis in patients with COVID-19 and myocardial injury: a case series. Eur Heart J Case Rep. 2021;5(6):ytab239. http://doi.org/10.1093/ehjcr/ytab239. PMid:34263128.	60	Male	Hypertension, schizophrenia	fever, dyspnea, desaturation (83% room air), altered consciousness	Sinus rhythm, left ventricular hypertrophy, prolonged QTc	mural thrombus and pulmonary embolism	CoVID-19 pneumonia	Heparin	NR	4
Cousin et al., 2014¹²12 Cousin E, Scholfield M, Faber C, Caldeira C, Guglin M. Treatment options for patients with mobile left ventricular thrombus and ventricular dysfunction: a case series. Heart Lung Vessel. 2014;6(2):88-91. PMid:25024990.	63	Male	HF	cardiogenic shock and hypotension	NR	None	Non-ischemic dilated cardiomyopathy	Surgical thrombectomy and LVAD	Recovery and discharge (with a plan for heart transplantation)	4
	50	Male	Biventricular HF and coagulopathy	dyspnea, bilateral lower limb edema, pneumonia, septic shock, and AKI	NR	None	HF/ coagulopathy (occluded right popliteal vein)	Surgical thrombectomy and BiVAD. Heart transplantation after 6 months.	Recovery and discharge	4
	64	Male	IHD, HF, chronic lymphocytic leukemia, and acute promyelocytic leukemia	NR	NR		IHD and HF	Surgical removal	Thrombus recurrence after 6 months of recovery.	4
Kanazawa et al., 2016¹³13 Kanazawa H, Kashima I, Mochizuki Y, et al. A “bowing” pedunculated large thrombus in the left ventricle and its formation. Int J Cardiol. 2016;222:841-3. http://doi.org/10.1016/j.ijcard.2016.08.035. PMid:27522386. http://doi.org/10.1016/j.ijcard.2016.08....	75	Female	NR	NR (referral)	Q waves v1-v4	None	Apical aneurysm due to asymptomatic MI	Surgical removal	NR	4
Allende et al., 2011¹⁴14 Allende NG, Sokn F, Borracci R, et al. Giant pedunculated thrombus with normal left ventricular systolic function mimicking myxoma. Echocardiography. 2011;28(2):E31-3. http://doi.org/10.1111/j.1540-8175.2010.01262.x. PMid:21198822. http://doi.org/10.1111/j.1540-8175.2010....	74	Female	essential thrombocythemia and previous unstable angina (PCI to the LAD)	Atypical chest pain and left hemiparesis (on the 2nd day of admission)	Normal then negative T wave	Brain and heart (distal LAD)	Combined essential thrombocythemia with IHD.	Surgical removal and saphenous vein graft to the distal LAD.	Improvement (of neurological symptoms) and discharge	4
Lutz et al., 2007¹⁵15 Lutz CJ, Bhamidipati CM, Ford B, et al. Robotic-assisted excision of a left ventricular thrombus. Innovations (Phila). 2007;2(5):251-3. http://doi.org/10.1097/imi.0b013e31815cea73. PMid:22437135. http://doi.org/10.1097/imi.0b013e31815ce...	34	Male	hyperlipidemia, gastroesophageal reflux disease, pyelonephritis, hydronephrosis, Crohn’s disease, ischemic colitis, and depression	Referral, FUO	NR	None	Ulcerative colitis	Surgical removal	Recovery and discharge (4 days)	4
Nili et al., 1988¹⁶16 Nili M, Deviri E, Jortner R, Strasberg B, Levy MJ. Surgical removal of a mobile, pedunculated left ventricular thrombus: report of 4 cases. Ann Thorac Surg. 1988;46(4):396-400. http://doi.org/10.1016/S0003-4975(10)64651-6. PMid:3178348. http://doi.org/10.1016/S0003-4975(10)646...	59	Male	Eight-month history of stable angina	Chest pain, acute anteroseptal MI followed by HF	NR	None	Acute MI and HF	Surgical removal and graft of the LAD	Recovery and discharge (14 days)	4
	56	Male	Polycythemia vera	left upper quadrant abdominal pain and fever for two weeks after anterior MI (treated by heparin infusion).	NR	Spleen	Acute MI and HF	Surgical removal of thrombus and double coronary bypass (LAD and LCX)	Recovery and discharge (22 days)	4
	46	Male	MI 1 year before presentation	Left common femoral artery occlusion	NR	Common femoral artery	MI (1 year before presentation)	Surgical removal of LV thrombi (thrombectomy)	Recovery and discharge (10 days)	4
	66	Male	eleven-year history of angina; MI 2 years; CABG candidate	Angina	NR	None	MI (2 years)	Surgical removal then CABG	Recovery and discharge (12 days)	4
Kharwar et al., 2014¹⁷17 Kharwar RB, Chandra S, Dwivedi SK, Saran RK. A pedunculated left ventricular thrombus in a women with peripartum cardiomyopathy: evaluation by three dimensional echocardiography. J Cardiovasc Ultrasound. 2014;22(3):139-43. http://doi.org/10.4250/jcu.2014.22.3.139. PMid:25309691. http://doi.org/10.4250/jcu.2014.22.3.139...	30	Female	Pregnancy (hypercoagulable state) with poor LV function	peripartum cardiomyopathy Orthopnea and dyspnea on exertion (3 weeks after delivery)	Sinus tachycardia	None	Peripartum cardiomyopathy (poor LV function and hypercoagulable state)	Oral anticoagulation (warfarin)	Complete dissolution (30 days) and improvement of systolic function to 43%	4
Ito et al., 2022¹⁸18 Ito H, Bessho S, Nakamura B, Toba S, Shomura Y, Takao M. Transmitral extraction of a huge left ventricular mural thrombus using a novel mitral leaflet retractor. Clin Case Rep. 2022;10(2):e05427. http://doi.org/10.1002/ccr3.5427. PMid:35369383. http://doi.org/10.1002/ccr3.5427...	52	Female	IHD	Discovered during an MRI study	NR	None	MI (15 years)	Surgical removal	recovery and discharge (10 days)	4
Singal et al., 2021¹⁹19 Singal AK, Deepti S, Sharma G, Kothari SS. Herculean mistake: mephentermine associated cardiomyopathy. Phys Sportsmed. 2021;49(1):116-22. http://doi.org/10.1080/00913847.2020.1763146. PMid:32404042. http://doi.org/10.1080/00913847.2020.176...	32	Male	Two-year history of anabolic androgenic steroid abuse and three-month history of mephentermine abuse.	Acute decompensated heart failure (plus left upper limb monoparesis and embolic TIA on the second day)	Sinus tachycardia and left ventricle enlargement	Brain (left parietal lobe and right cerebellum)	Toxic cardiomyopathy (secondary to mephentermine and/or anabolic androgenic steroid abuse)	Anticoagulant (warfarin)	Complete dissolution (with an improvement of NYHA classification and LV function after two weeks)
Tanaka et al., 2014²⁰20 Tanaka D, Unai S, Diehl JT, Hirose H. Surgical removal of a large mobile left ventricular thrombus via left atriotomy. World J Clin Cases. 2014;2(2):32-5. http://doi.org/10.12998/wjcc.v2.i2.32. PMid:24579068. http://doi.org/10.12998/wjcc.v2.i2.32...	37	Female	Pregnancy (hypercoagulable state) with poor LV function	Exertional dyspnea and fatigue	NR	None	Peripartum cardiomyopathy (poor LV function and hypercoagulable state)	Surgical removal	Recovery and discharge (day 10)	4
Jeganathan et al., 2011²¹21 Jeganathan R, Ralph‐Edwards A. Left apical pedunculated thrombus with normal ventricular function mimicking an intracardiac tumor. J Card Surg. 2011;26(6):614-6. http://doi.org/10.1111/j.1540-8191.2011.01304.x. PMid:21951172. http://doi.org/10.1111/j.1540-8191.2011....	62	Male	Hypertension, renal impairment, and colon cancer treated surgically (4 years)	Right acute limb/leg ischemia with compartment syndrome	NR	Right popliteal artery	Idiopathic	Surgical removal	Recovery and discharge	4
Janula et al., 2021²²22 Janula M, Navarro A, Bonello J, Schembri K, Borg A. Trans-aortic left ventricular thrombo-embolectomy following COVID-19 infection. J Surg Case Rep. 2021;(9):rjab426. http://doi.org/10.1093/jscr/rjab426. PMid: 34594494.	47	Male	Diabetes mellitus, obesity, and dyslipidemia	NSTEMI in the context of CoVID-19 infection, fever, and expressive aphasia developed during hospital stay (day 4)	RBBB	Right occipital and left temporal regions (with micro-hemorrhagic transformation, contraindication for anticoagulation)	procoagulant state of CoVID-19 and acute MI	Surgical removal	Recovery	4
Marchini et al., 2009²³23 Marchini JFM, Rodrigues AJ, Schmidt A. A ventricular thrombus mimicking a tumour. BMJ Case Rep. 2009;2009:bcr06.2009.1944. http://doi.org/10.1136/bcr.06.2009.1944. PMid:21886661. http://doi.org/10.1136/bcr.06.2009.1944...	33	Female	Hypertension, smoking, and repeated miscarriage	Dyspnea and lower limb edema for 3 years (NYHA II)	Q waves I, aVL; st depression II and III; T wave inversion I, aVL, V5, and V6; and LV hypertrophy	None	HF	Surgical removal	Recovery (discharge 9 days)	4
Mukai et al., 1991²⁴24 Mukai S, Fuseno H, Nakamura M, Yoshikawa J, Shomura T. Dilated cardiomyopathy complicated by a pedunculated and mobile left ventricular thrombus on ruptured false tendons. Chest. 1991;99(4):1042-3. http://doi.org/10.1378/chest.99.4.1042. PMid:2009765. http://doi.org/10.1378/chest.99.4.1042...	68	Male	Diabetes	Congestive heart failure (thrombus developed during the hospital stay, on the 15^th day)	Sinus tachycardia, mild LV hypertrophy	None	Dilated cardiomyopathy	Surgical removal	Recovery	4
Park et al., 1986²⁵25 Park JE, Kim WJ, Choi DS, Suh SK, Whang JW, Kim HM. A large pedunculated left ventricular thrombus with recurrent systemic thromboembolism in a young man. Korean J Intern Med (Korean Assoc Intern Med). 1986;1(2):254-8. http://doi.org/10.3904/kjim.1986.1.2.254. PMid:3154622. http://doi.org/10.3904/kjim.1986.1.2.254...	33	Male	IHD (inferior STEMI 6 years before presentation), emboli to the right femoral artery and left internal iliac artery (failed bypass and right above-knee amputation)	Mesenteric artery thromboembolism (abdominal pain)		mesenteric artery	MI (6 years)	Surgical removal	Recovery without recurrence (complicated with an embolus to the left femoral artery on the 20^th day, which was treated with left above-knee amputation.	4
Bakhtiari et al., 2012²⁶26 Bakhtiari RE, Khaledifar A, Kabiri M, Danesh Z. Mobile pedunculated left ventricular masses in a man with recurrent emboli. Heart Views. 2012;13(4):146-8. http://doi.org/10.4103/1995-705X.105734. PMid:23439797. http://doi.org/10.4103/1995-705X.105734...	51	Male	Diabetes mellitus, hypertension, hyperlipidemia, IHD (MI 3 years prior)	Two-week history of right-sided weakness, left-sided paresthesia, and visual disturbance bilaterally.		Brain (bioccipital, basal ganglia, and internal capsule)	MI (3 years)	Surgical removal	Recovery	4
Chen et al., 1981²⁷27 Chen CC, Webster GW, Morganroth J. Large mobile pedunculated left ventricular thrombus: Identification by two‐dimensional echocardiography. Clin Cardiol. 1981;4(4):189-92. http://doi.org/10.1002/clc.4960040407. PMid:7273502. http://doi.org/10.1002/clc.4960040407...	74	Male	IHD, ventricular ectopy, congestive cardiomyopathy, and diabetes mellitus	Dysarthria, weakness, and ataxia		Brain	Idiopathic congestive cardiomyopathy	IV heparin	Death	4
Rester et al., 2001²⁸28 Rester BT, Warnock JL, Patel PB, McMullan MR, Skelton TN, Collop NA. Lysis of a left ventricular thrombus with recombinant tissue plasminogen activator. Chest. 2001;120(2):681-3. http://doi.org/10.1378/chest.120.2.681. PMid:11502681. http://doi.org/10.1378/chest.120.2.681...	23	Female	Pregnancy-induced hypertension and peripartum cardiomyopathy	Fatigue, shortness of breath, and bilateral flank pain.	Sinus tachycardia with non-specific ST-T segment abnormality	Spleen, right kidney	Peripartum cardiomyopathy (poor LV function and hypercoagulable state)	RTPA (after failure of heparin infusion and enlargement of the thrombus size)	Recovery (complete lysis of the thrombus after 8-10 hours)	4
Azari et al., 2021²⁹29 Azari A, Amini O, Lakziyan R, Sarchahi Z. Mesenteric ischemia following large left ventricular fibroid thrombosis due to myocardial infarction: a case report. Int J Surg Case Rep. 2021;81:105833. http://doi.org/10.1016/j.ijscr.2021.105833. PMid:33887862. http://doi.org/10.1016/j.ijscr.2021.1058...	45	Male	Diabetes mellitus, hypertension, smoking, and alcohol intake	Negligible MI (severe epigastric pain, fever, sweating, and tachycardia)	Q waves in V1-2 and biphasic T wave V2-4	mesenteric artery	Acute MI and HF	Surgical removal	Recovery	4
Chen et al., 2008³⁰30 Chen Z, Robinson N, Harkness A. Pedunculated left ventricular thrombus presenting with acute ischaemic limb. Emerg Med J. 2008;25(4):216. http://doi.org/10.1136/emj.2007.049585. PMid:18356352. http://doi.org/10.1136/emj.2007.049585...	84	Male	IHD (anterior MI 8 years ago), and AF	Acute left lower limb ischemia	NR	Left lower limb	MI (8 years)	Surgical removal	NR	4
Kumar et al., 2022³¹31 Kumar P, Rao MS, Lalani K, Paramasivam G, Devasia T, Parikh P. Dabigatran for intracardiac thrombus, yet another promising role of a direct oral anticoagulant: a case report and short review of literature. Arch Clin Cases. 2022;9(2):75-9. http://doi.org/10.22551/2022.35.0902.10207. PMid: 35813493.	57	Male	None	Bilateral acute lower limb ischemia with absent dorsalis pedis and posterior tibial artery pulses bilaterally	Normal	mid and distal anterior tibial and dorsalis pedis bilaterally	Idiopathic	Aspirin® (150 mg), clopidogrel (75 mg), and LMWH for 48 hours/ till leg numbness disappeared. Then antiplatelet plus dabigatran 110 mg for two weeks (till the thrombus disappeared). Resumed on aspirin® plus dabigatran 150 mg twice daily for 6 months.	Recovery of leg condition and lysis of the LV thrombus	4
Eren et al., 2013³²32 Eren NK, Emren SV, Duygu H, Kocabas U. Left ventricular thrombus formation in a patient with normal ejection fraction. Turk Kardiyol Dern Ars. 2013;41(7):625-8. http://doi.org/10.5543/tkda.2013.71598. PMid:24164994. http://doi.org/10.5543/tkda.2013.71598...	45	Female	NR	Cerebrovascular accident (loss of consciousness for 15 minutes followed by ataxia)	Normal (sinus rhythm)	Brain (bilateral infarcts)	Idiopathic	Surgical removal	NR	4
Daley et al., 1987³³33 Daley P, Ptacin M, Horwitz M, Werner P, Almagro U, Bamrah V. Left ventricular thrombus in agnogenic myeloid metaplasia. Cardiology. 1987;74(1):53-7. http://doi.org/10.1159/000174175. PMid:3815454. http://doi.org/10.1159/000174175...	40	Male	Agnogenic myeloid metaplasia	Maculopapular rash, fever, and pleuro-pericardial pain	Normal	None	Idiopathic myocarditis and spontaneous platelet aggregation.	Surgical removal	Recovery and discharge (4 weeks)
John et al., 1991³⁴34 John RM, Sturridge MF, Swanton RH. Pedunculated left ventricular thrombus--report of two cases. Postgrad Med J. 1991;67(791):843-5. http://doi.org/10.1136/pgmj.67.791.843. PMid:1946132. http://doi.org/10.1136/pgmj.67.791.843...	63	Female	Peptic ulcer	MI	Inverted T wave I, aVL, and V2-6	None	Acute MI	Surgical removal	Recovery and discharge.	4
	56	Male	NR	Unstable angina (4 weeks)	Q waves anteriorly	None	Acute MI	Surgical removal	Recovery and discharge.	4
Lewin et al., 1980³⁵35 Lewin RF, Vidne B, Sclarovsky S, Agmon J. Two-dimensional real-time echocardiographic detection of a left ventricular aneurysm associated with mobile pedunculated thrombi. Chest. 1980;77(5):704-6. http://doi.org/10.1378/chest.77.5.704. PMid:7363697. http://doi.org/10.1378/chest.77.5.704...	51	Male	IHD (inferior MI 6 years and anterolateral MI 4.5 years backward)	Bilateral acute limb ischemia	Old inferior and anterior MI (persistent ST elevation)	bilateral to the Iliac arteries	Aneurysm of the anterior wall	Surgical removal of the thrombus with aneurysmectomy	Recovery and discharge (14 days)	4
Shetty et al., 2011³⁶36 Shetty K, Sunkara N, Ahsan C. Recurrent intra-cardiac thrombosis—A unique presentation of prothrombin G20210 mutation. J Cardiol Cases. 2011;3(3):e129-32. http://doi.org/10.1016/j.jccase.2011.02.002. PMid:30524602. http://doi.org/10.1016/j.jccase.2011.02....	49	Female	Anxiety, hypertension, and surgical history of hysterectomy.	One month history of exertional dyspnea	NR	None	prothrombin G20210 mutation	Surgical removal followed by anticoagulation (enoxaparin and warfarin then warfarin).	Recovery and discharge. Complicated by atrial mass after 6 weeks, dissolved medically after two months of medical treatment	4
Vaganos et al., 1989³⁷37 Steve AV, Kevin RF, James GK 3rd. Left ventricular thrombus in the absence of detectable heart disease. Chest. 1989;96(2):426-7. http://doi.org/10.1378/chest.96.2.426. PMid:2752829. http://doi.org/10.1378/chest.96.2.426...	43	Female	history of bilateral DVT and pulmonary emboli.	Eight-hour history of pain, pallor, pulselessness, and paralysis of the left leg.	Normal	Left common femoral artery	Possible hypercoagulable state	Surgical removal	Recovery	4
Lew et al., 1983³⁸38 Lew AS, Federman J, Harper RW, et al. Operative removal of mobile pedunculated left ventricular thrombus detected by 2-dimensional echocardiography. Am J Cardiol. 1983;52(8):1148-9. http://doi.org/10.1016/0002-9149(83)90554-4. PMid:6637840. http://doi.org/10.1016/0002-9149(83)9055...	63	Male	history of DVT and pulmonary embolism ( the patient was already on IV heparin)	Acute right limb ischemia		Right femoral artery	Possible hypercoagulable state	Surgical removal	Recovery	4
Chamsi-Pasha et al., 2009³⁹39 Chamsi-Pasha MA, Anwar AM, Nosir YF, Chamsi-Pasha H. Hanging by a thread" left ventricular thrombus in an asymptomatic soldier. Saudi Med J. 2009;30(3):436-8. PMid:19271079.	32	Male	None	Routine echocardiography (asymptomatic)	Normal	None	Idiopathic cardiomyopathy	Warfarin overlapped with enoxaparin maintaining INR 2-3, then warfarin for 6 months	Complete dissolution after 6 weeks	4
Early et al., 2001⁴⁰40 Early GL, Ballenger M, Hannah H 3rd, Roberts SR. Simplified method of left ventricular thrombectomy. Ann Thorac Surg. 2001;72(3):953-4. http://doi.org/10.1016/S0003-4975(00)02607-2. PMid:11565702. http://doi.org/10.1016/S0003-4975(00)026...	64	Female	NR	Acute anterior MI, received thrombolytic therapy + no LV thrombus on presentation	Anterior STEMI	None	Acute MI	Surgical removal	Recovery	4
Wohlfarter et al., 1991⁴¹41 Wohlfarter T, Hopferwieser T, Schwaighofer H, et al. An idiopathic floating left-ventricular thrombus. Dtsch Med Wochenschr. 1991;116(21):808-11. http://doi.org/10.1055/s-2008-1063682. PMid:2032531. http://doi.org/10.1055/s-2008-1063682...	28	Male	Appendectomy (4 weeks)	Occlusion of the left superior femoral A at the adductor canal (dragging pain at the cuff)		Left superior femoral artery		Heparin failed, systemic thrombolysis with streptokinase 750000 IU replaced by ancrod 70 IU/day IV for increased movement, then heparin 3000 IU IV	Recovery (thrombus size decreased to 0.7 after 5 days, then it disappeared after two weeks)	4
Palazzuoli et al., 1994⁴²42 Palazzuoli V, Mondillo S, D’Aprile N, Faglia S, Palazzuoli A. Heparin treatment and resolution of left ventricular thrombosis. Int J Cardiol. 1994;43(3):338-40. http://doi.org/10.1016/0167-5273(94)90217-8. PMid:8181893. http://doi.org/10.1016/0167-5273(94)9021...	70	Male	bilateral lower limb arteriopathy.	Episodes of disorientation	Recent inferior MI	None	Acute MI	Calcium heparin 12500 IU/ 8 hours	Complete dissolution after 20 days.	4
Jeon et al., 2012⁴³43 Jeon GJ, Song BG, Park YH, Kang GH, Chun WJ, Oh JH. Acute stroke and limb ischemia secondary to catastrophic massive intracardiac thrombus in a 40-year-old patient with dilated cardiomyopathy. Cardiol Res. 2012;3(1):37-40. http://doi.org/10.4021/cr142w. PMid:28357023. http://doi.org/10.4021/cr142w...	40	Male	None	Stroke and acute limb ischemia (dyspnea, right facial and limb weakness as well as both lower limb pain, pulselessness and coldness).	Sinus rhythm with diffuse non-specific ST segment changes.	Brain, right femoral and right popliteal, and left popliteal arteries	Idiopathic dilated cardiomyopathy	Surgical removal	Recovery and discharge (7 days)	4
Chirillo et al., 1996⁴⁴44 Chirillo F, Furlanetto A, Bruni A, Martines M, Stritoni P. Atypical electromechanical dissociation in a patient with recurrent pulmonary embolism. Chest. 1996;109(2):562-3. http://doi.org/10.1378/chest.109.2.562. PMid:8620738. http://doi.org/10.1378/chest.109.2.562...	47	Male	Recurrent pulmonary embolism, DVT (bilateral femoral and saphenous), smoking, and left lung cancer	Bilateral pulmonary embolism, left pulmonary infarction masking tumor, and thrombosis in the IVC (Sudden dyspnea, tachycardia, and hypoxemia)	RBBB	Lung, lower limb, IVC	Hypercoagulable state resistant to anticoagulation (paraneoplastic hypercoagulable state)	Heparin and RTPA after 5 days	Death (electromechanical dissociation due to RVOT obstruction)	4
DeWitt et al., 1988⁴⁵45 DeWitt LD, Pessin MS, Pandian NG, Paulker SG, Sonnenberg FA, Caplan LR. Benign disappearance of ventricular thrombus after embolic stroke. A case report. Stroke. 1988;19(3):393-6. http://doi.org/10.1161/01.STR.19.3.393. PMid:3354027. http://doi.org/10.1161/01.STR.19.3.393...	80	Female	None	Stroke (right upper limb weakness and speech abnormality)	Nonspecific ST and T wave changes	Brain	Idiopathic	Heparin then warfarin.	Recovery and dissolution of thrombus (12 days)	4
Hwang et al., 1985⁴⁶46 Hwang MH, Pacold I, Loeb HS. Acute anterior myocardial infarction complicated by mural thrombus and peripheral thromboembolism despite anticoagulation. Cathet Cardiovasc Diagn. 1985;11(4):417-22. http://doi.org/10.1002/ccd.1810110411. PMid:4042158. http://doi.org/10.1002/ccd.1810110411...	43	Male	None	Anterior MI (2 weeks)	NR	Superior mesenteric artery	Acute MI	Surgical removal	Recovery and discharge.	4
Çil et al., 2013⁴⁷47 Çil H, Yavuz C, Atilgan ZA, Gunduz E, Soydinc S. Complete resolution of the left ventricular pedunculated thrombus with tirofiban infusion in a patient with severe left ventricular dysfunction. Hong Kong J Emerg Med. 2013;20(5):305-8. http://doi.org/10.1177/102490791302000508. http://doi.org/10.1177/10249079130200050...	28	Male	IHD (anterior MI 2 years)	Deteriorating dyspnea (decompensated heart failure NYHA class IV)	Anterior ST-segment elevation	None	Essential thrombocythemia, previous IHD with resultant aneurysm, and HF	Tirofiban after failed heparin infusion (1000 IU/hour for 48 hours)	Complete dissolution after 48 hours (decreased size after 24 hours to 1.8*0.7)/ recovery and discharge (on the 6th day)	4
Seitz et al., 2012⁴⁸48 Seitz MJ, McLeod MK, O’Keefe MD, Seah PW. A rare cause of Takotsubo cardiomyopathy related left ventricular apical thrombus requiring surgery. Heart Lung Circ. 2012;21(4):245-6. http://doi.org/10.1016/j.hlc.2011.07.004. PMid:21840755. http://doi.org/10.1016/j.hlc.2011.07.004...	48	Male	Cystic fibrosis	DCL, hemoptysis, dyspnea, and respiratory arrest	NR	None	Takotsubo cardiomyopathy	Surgical removal	Recovery and discharge (on day 5 after the operation)	4
Manasrah et al., 2022⁴⁹49 Manasrah N, Abdel-Qader A, Al Sbihi A, et al. Left ventricular thrombus formation in a structurally and functionally normal heart: a case report and literature review. J Investig Med High Impact Case Rep. 2022;10:23247096221101852. http://doi.org/10.1177/23247096221101852. PMid:35619244. http://doi.org/10.1177/23247096221101852...	54	Female	Type II DM and smoking	Two-hour history of right leg pain.	RBBB	The aortoiliac bifurcation, bilateral common iliac arteries, and proximal left internal iliac artery	Idiopathic	Surgical removal	Recovery and discharge	4
Jeganathan and Ralph‐Edwards, 2011⁵⁰50 Jeganathan R, Ralph‐Edwards A. Left apical pedunculated thrombus with normal ventricular function mimicking an intracardiac tumor. J Card Surg. 2011;26(6):614-6. http://doi.org/10.1111/j.1540-8191.2011.01304.x. PMid:21951172. http://doi.org/10.1111/j.1540-8191.2011....	62	Male	Hypertension, colorectal carcinoma, and renal impairment.	Acute right leg ischemia	NR	Right popliteal artery	Idiopathic	Surgical removal (after heparin failed)	Recovery and discharge	4
Erkal et al., 2017⁵¹51 Erkal Z, Bayar N, Arslan Ş. A case of thrombus formation in a patient with preserved left ventricle ejection fraction and development of peripheral embolization. Cyprus J Med Sci. 2017;2(2):38-9. http://doi.org/10.5152/cjms.2017.158. http://doi.org/10.5152/cjms.2017.158...	63	Male	Right femoral embolectomy 2 weeks before presentation	Left femoral artery occlusion	Normal sinus rhythm	Left femoral artery	Idiopathic	Medical treatment	Recovery	4
Maruri-Sánchez et al., 2019⁵²52 Maruri-Sánchez R, Diego-Nieto G, Monguió-Santín ME, Calle-Valda CM, Reyes-Copa G, Alfonso F. An intraventricular thrombus of unknown origin. Arch Cardiol Mex. 2019;89(3):267-9. PMid:31967595.	38	Male	Smoking, dyslipidemia, hypertension, and left lower limb DVT 2 years ago	Stroke	NR	right MCA	Idiopathic	Surgical removal	Recovery and discharge	4
Muller et al., 1996⁵³53 Müller S, Bartel T, Laube H. Left ventricular thrombus after pregnancy: choice of surgical access using dynamic three‐dimensional echocardiography. Echocardiography. 1996;13(3):293-6. http://doi.org/10.1111/j.1540-8175.1996.tb00899.x. PMid:11442934. http://doi.org/10.1111/j.1540-8175.1996....	41	Female	Hypertension	Stroke	Left anterior hemiblock, and non-specific ST-T wave changes	Left MCA	Idiopathic	Surgical removal	Recovery (the patient had post-operative wound infection)	4
Lin et al., 2004⁵⁴54 Lin CP, Tsai FC, Chu PH, et al. Acute myocardial infarction in a young man complicated with left ventricular thrombi. Jpn Heart J. 2004;45(6):1029-35. http://doi.org/10.1536/jhj.45.1029. PMid:15655278. http://doi.org/10.1536/jhj.45.1029...	23	Male	None	MI (acute proximal LAD lesion), TIA, transient loss of vision 5 min the day before presentation.	Q waves V1 to V5 and low voltage limb leads	Brain (TIA)	Acute MI and premature coronary artery disease	Heparin then surgical removal	Recovery and discharge	4
Kuroki and Murakami, 2012⁵⁵55 Kuroki K, Murakami T. Thoracoscopy-assisted removal of left ventricular thrombus via minithoracotomy. Asian Cardiovasc Thorac Ann. 2012;20(1):77-9. http://doi.org/10.1177/0218492311424466. PMid:22371951. http://doi.org/10.1177/0218492311424466...	58	Female	None	MI (acute LAD occlusion), chest pain for two days	Anterior ST elevation	None	Acute MI	Surgical removal	Recovery	4
Rao et al., 1990⁵⁶56 Rao PV, Roussak JB, Hershman MJ, Venn GE, Taylor KM. An unusual left ventricular mass. J R Soc Med. 1990;83(10):650-1. http://doi.org/10.1177/014107689008301019. PMid:2286968. http://doi.org/10.1177/01410768900830101...	71	Female	NR	Constitutional symptoms mostly Dressler’s syndrome following silent MI, masked by RBBB.	Sinus rhythm with RBBB then AF	None	Acute silent MI	Surgical removal	Recovery	4
Zaikokuji et al., 2018⁵⁷57 Zaikokuji K, Sawazaki M, Tomari S, Uemura T. Transmitral thrombectomy to treat a patient with Takotsubo cardiomyopathy. Asian Cardiovasc Thorac Ann. 2018;26(3):236-8. http://doi.org/10.1177/0218492317729618. PMid:28870088. http://doi.org/10.1177/0218492317729618...	68	Female	Bipolar disorders	Gastric ulcer (upper abdominal discomfort)	ST-segment depression and T wave inversion V3-V6	None	Takotsubo cardiomyopathy	Surgical removal	Recovery (discharged on day 15 postoperative)	4
Ho et al., 2008⁵⁸58 Ho JK, Dhamija N, Yezbick A, Mahajan A, Marijic J. Left ventricular mass: intraoperative transesophageal echocardiography for evaluation and management. Anesth Analg. 2008;107(4):1153-4. http://doi.org/10.1213/ane.0b013e3181806681. PMid:18806017. http://doi.org/10.1213/ane.0b013e3181806...	29	Male	Cocaine use	Embolic stroke	NR	Brain	MI (substance abuse)	Surgical removal	Recovery	4

Author/ year	LV thrombus Site	Thrombus dimensions by echocardiography (Cm)/ (pathology specimen)	Other significant echocardiographic findings
Kumar et al., 2016⁹9 Kumar USD, Shetty SP, Sujay KR, Wali M. Left ventricular mass: a tumor or a thrombus diagnostic dilemma. Ann Card Anaesth. 2016;19(4):728-32. http://doi.org/10.4103/0971-9784.191551. PMid:27716707. http://doi.org/10.4103/0971-9784.191551...	Apical and anterior mitral leaflet	3.8* 1.9/ pathology (421)	EF 50%; hypokinetic apex and apical segment.
Grewal et al., 2021¹⁰10 Grewal HK, Bansal M, Garg A, Kasliwal RR, Bhan A, Gautam D. Left ventricular thrombus and cardioembolic stroke in a patient with ulcerative colitis: a case report. Saudi J Med Med Sci. 2021;9(1):67-70. http://doi.org/10.4103/sjmms.sjmms_525_19. PMid:33519347. http://doi.org/10.4103/sjmms.sjmms_525_1...	Apical	1.9*1	Normal systolic function, no segmental wall motion abnormality
Garg et al., 2021¹¹11 Garg A, Hakeem H, Chennu G, et al. Left ventricular mural thrombi with multisystem thrombosis in patients with COVID-19 and myocardial injury: a case series. Eur Heart J Case Rep. 2021;5(6):ytab239. http://doi.org/10.1093/ehjcr/ytab239. PMid:34263128.	Apical, apical anterior, lateral, and inferior walls.	Largest was 3*3	Moderately reduced LV function
Cousin et al., 2014¹²12 Cousin E, Scholfield M, Faber C, Caldeira C, Guglin M. Treatment options for patients with mobile left ventricular thrombus and ventricular dysfunction: a case series. Heart Lung Vessel. 2014;6(2):88-91. PMid:25024990.	Apical	3.3*2.5	EF 5- 10% and dilated LV with global hypokinesia
	Apex, septum, and anterior wall	4.2* 3.5	EF 15- 20%, global hypokinesia, apical akinesia, and dilated right ventricle.
	Apical	2.5* 1.7	Moderate global hypokinesia, severe hypokinesia inferiorly, and inferoseptally.
Kanazawa et al., 2016¹³13 Kanazawa H, Kashima I, Mochizuki Y, et al. A “bowing” pedunculated large thrombus in the left ventricle and its formation. Int J Cardiol. 2016;222:841-3. http://doi.org/10.1016/j.ijcard.2016.08.035. PMid:27522386. http://doi.org/10.1016/j.ijcard.2016.08....	Apical	NR	EF 40%, akinesia from the anteroseptal wall to the apex.
Allende et al., 2011¹⁴14 Allende NG, Sokn F, Borracci R, et al. Giant pedunculated thrombus with normal left ventricular systolic function mimicking myxoma. Echocardiography. 2011;28(2):E31-3. http://doi.org/10.1111/j.1540-8175.2010.01262.x. PMid:21198822. http://doi.org/10.1111/j.1540-8175.2010....	Mid-anterior wall	2.5*1.4	On the first day, normal systolic function and mild left atrial enlargement. On the second day, EF was 52% with hypokinesia of the apical segments.
Lutz et al., 2007¹⁵15 Lutz CJ, Bhamidipati CM, Ford B, et al. Robotic-assisted excision of a left ventricular thrombus. Innovations (Phila). 2007;2(5):251-3. http://doi.org/10.1097/imi.0b013e31815cea73. PMid:22437135. http://doi.org/10.1097/imi.0b013e31815ce...	Apical	1.31.7 (10.9*1.7 after excision)	Normal LV systolic function
Nili et al., 1988¹⁶16 Nili M, Deviri E, Jortner R, Strasberg B, Levy MJ. Surgical removal of a mobile, pedunculated left ventricular thrombus: report of 4 cases. Ann Thorac Surg. 1988;46(4):396-400. http://doi.org/10.1016/S0003-4975(10)64651-6. PMid:3178348. http://doi.org/10.1016/S0003-4975(10)646...	interventricular septum	4*3	EF 26%, dilated LV, akinetic septum, and dyskinetic anterior wall.
	Apical	2*2	EF 28%,
	NR	NR (two pedunculated thrombi)	NR
	NR	1.5*2	NR
Kharwar et al., 2014¹⁷17 Kharwar RB, Chandra S, Dwivedi SK, Saran RK. A pedunculated left ventricular thrombus in a women with peripartum cardiomyopathy: evaluation by three dimensional echocardiography. J Cardiovasc Ultrasound. 2014;22(3):139-43. http://doi.org/10.4250/jcu.2014.22.3.139. PMid:25309691. http://doi.org/10.4250/jcu.2014.22.3.139...	Interventricular septum	2.5*2	EF 32%, global hypokinesia, and dilated four chambers.
Ito et al., 2022¹⁸18 Ito H, Bessho S, Nakamura B, Toba S, Shomura Y, Takao M. Transmitral extraction of a huge left ventricular mural thrombus using a novel mitral leaflet retractor. Clin Case Rep. 2022;10(2):e05427. http://doi.org/10.1002/ccr3.5427. PMid:35369383. http://doi.org/10.1002/ccr3.5427...	Ventricular free wall.	NR	Ef 25% and anterior wall akinesia
Singal et al., 2021¹⁹19 Singal AK, Deepti S, Sharma G, Kothari SS. Herculean mistake: mephentermine associated cardiomyopathy. Phys Sportsmed. 2021;49(1):116-22. http://doi.org/10.1080/00913847.2020.1763146. PMid:32404042. http://doi.org/10.1080/00913847.2020.176...	Apical	3.4*1.6	Biventricular systolic dysfunction (EF of 20%), global hypokinesia, and severe central MR
Tanaka et al., 2014²⁰20 Tanaka D, Unai S, Diehl JT, Hirose H. Surgical removal of a large mobile left ventricular thrombus via left atriotomy. World J Clin Cases. 2014;2(2):32-5. http://doi.org/10.12998/wjcc.v2.i2.32. PMid:24579068. http://doi.org/10.12998/wjcc.v2.i2.32...	Apical	3*3	EF 10%
Jeganathan et al., 2011²¹21 Jeganathan R, Ralph‐Edwards A. Left apical pedunculated thrombus with normal ventricular function mimicking an intracardiac tumor. J Card Surg. 2011;26(6):614-6. http://doi.org/10.1111/j.1540-8191.2011.01304.x. PMid:21951172. http://doi.org/10.1111/j.1540-8191.2011....	Apical	3*1	Normal
Janula et al., 2021²²22 Janula M, Navarro A, Bonello J, Schembri K, Borg A. Trans-aortic left ventricular thrombo-embolectomy following COVID-19 infection. J Surg Case Rep. 2021;(9):rjab426. http://doi.org/10.1093/jscr/rjab426. PMid: 34594494.	Apical	NR	EF 35% with akinetic septum, anteroseptal, and anterior walls.
Marchini et al., 2009²³23 Marchini JFM, Rodrigues AJ, Schmidt A. A ventricular thrombus mimicking a tumour. BMJ Case Rep. 2009;2009:bcr06.2009.1944. http://doi.org/10.1136/bcr.06.2009.1944. PMid:21886661. http://doi.org/10.1136/bcr.06.2009.1944...	Interventricular septum	4.6* 1.2	EF 41%, an akinetic distal portion of the septum, anterior wall, and the whole apex.
Mukai et al., 1991²⁴24 Mukai S, Fuseno H, Nakamura M, Yoshikawa J, Shomura T. Dilated cardiomyopathy complicated by a pedunculated and mobile left ventricular thrombus on ruptured false tendons. Chest. 1991;99(4):1042-3. http://doi.org/10.1378/chest.99.4.1042. PMid:2009765. http://doi.org/10.1378/chest.99.4.1042...	lateral wall (near the apex)	11 (1.21*0.7)	EF 44%, global hypokinesia, akinetic apex, and dilated LV
Park et al., 1986²⁵25 Park JE, Kim WJ, Choi DS, Suh SK, Whang JW, Kim HM. A large pedunculated left ventricular thrombus with recurrent systemic thromboembolism in a young man. Korean J Intern Med (Korean Assoc Intern Med). 1986;1(2):254-8. http://doi.org/10.3904/kjim.1986.1.2.254. PMid:3154622. http://doi.org/10.3904/kjim.1986.1.2.254...	Apical	73 (74.5*2.7)	Slightly enlarged LV cavity, akinetic apex, and distal septum
Bakhtiari et al., 2012²⁶26 Bakhtiari RE, Khaledifar A, Kabiri M, Danesh Z. Mobile pedunculated left ventricular masses in a man with recurrent emboli. Heart Views. 2012;13(4):146-8. http://doi.org/10.4103/1995-705X.105734. PMid:23439797. http://doi.org/10.4103/1995-705X.105734...	Posterior wall and anterolateral wall (mid-segment)	Posterior wall: 2.51.8 (2.52 after excision). Anterolateral wall 2.82.2 (34 after excision)	Mild LV dilatation with LVEF 35-40%, akinetic basal inferior, and hypokinetic lateral wall (basal and mid segments)
Chen et al., 1981²⁷27 Chen CC, Webster GW, Morganroth J. Large mobile pedunculated left ventricular thrombus: Identification by two‐dimensional echocardiography. Clin Cardiol. 1981;4(4):189-92. http://doi.org/10.1002/clc.4960040407. PMid:7273502. http://doi.org/10.1002/clc.4960040407...	Apical	NR	dilated LV with global hypokinesia.
Rester et al., 2001²⁸28 Rester BT, Warnock JL, Patel PB, McMullan MR, Skelton TN, Collop NA. Lysis of a left ventricular thrombus with recombinant tissue plasminogen activator. Chest. 2001;120(2):681-3. http://doi.org/10.1378/chest.120.2.681. PMid:11502681. http://doi.org/10.1378/chest.120.2.681...	Apical	2.1*2.5	LVEF decreased from 40% (anteroseptal and inferior wall hypokinesia, LA enlargement, mild MR, and mild TR) to 25%.
Azari et al., 2021²⁹29 Azari A, Amini O, Lakziyan R, Sarchahi Z. Mesenteric ischemia following large left ventricular fibroid thrombosis due to myocardial infarction: a case report. Int J Surg Case Rep. 2021;81:105833. http://doi.org/10.1016/j.ijscr.2021.105833. PMid:33887862. http://doi.org/10.1016/j.ijscr.2021.1058...	Apical	1.7*1.9	LVEF 40%
Chen et al., 2008³⁰30 Chen Z, Robinson N, Harkness A. Pedunculated left ventricular thrombus presenting with acute ischaemic limb. Emerg Med J. 2008;25(4):216. http://doi.org/10.1136/emj.2007.049585. PMid:18356352. http://doi.org/10.1136/emj.2007.049585...		NR	NR
Kumar et al., 2022³¹31 Kumar P, Rao MS, Lalani K, Paramasivam G, Devasia T, Parikh P. Dabigatran for intracardiac thrombus, yet another promising role of a direct oral anticoagulant: a case report and short review of literature. Arch Clin Cases. 2022;9(2):75-9. http://doi.org/10.22551/2022.35.0902.10207. PMid: 35813493.	Apical	3.4*1.1	Normal LVEF
Eren et al., 2013³²32 Eren NK, Emren SV, Duygu H, Kocabas U. Left ventricular thrombus formation in a patient with normal ejection fraction. Turk Kardiyol Dern Ars. 2013;41(7):625-8. http://doi.org/10.5543/tkda.2013.71598. PMid:24164994. http://doi.org/10.5543/tkda.2013.71598...	Apical	1.8*0.8	Normal (LVEF 67%)
Daley et al., 1987³³33 Daley P, Ptacin M, Horwitz M, Werner P, Almagro U, Bamrah V. Left ventricular thrombus in agnogenic myeloid metaplasia. Cardiology. 1987;74(1):53-7. http://doi.org/10.1159/000174175. PMid:3815454. http://doi.org/10.1159/000174175...	Posterior wall	2	Normal
John et al., 1991³⁴34 John RM, Sturridge MF, Swanton RH. Pedunculated left ventricular thrombus--report of two cases. Postgrad Med J. 1991;67(791):843-5. http://doi.org/10.1136/pgmj.67.791.843. PMid:1946132. http://doi.org/10.1136/pgmj.67.791.843...	Apical	1*2.5	Normal
	Apical	1*1.5	Anteroapical akinesia
Lewin et al., 1980³⁵35 Lewin RF, Vidne B, Sclarovsky S, Agmon J. Two-dimensional real-time echocardiographic detection of a left ventricular aneurysm associated with mobile pedunculated thrombi. Chest. 1980;77(5):704-6. http://doi.org/10.1378/chest.77.5.704. PMid:7363697. http://doi.org/10.1378/chest.77.5.704...	Anterolateral	NR	Anterior wall aneurysm.
Shetty et al., 2011³⁶36 Shetty K, Sunkara N, Ahsan C. Recurrent intra-cardiac thrombosis—A unique presentation of prothrombin G20210 mutation. J Cardiol Cases. 2011;3(3):e129-32. http://doi.org/10.1016/j.jccase.2011.02.002. PMid:30524602. http://doi.org/10.1016/j.jccase.2011.02....	posterolateral papillary muscle	NR	Normal
Vaganos et al., 1989³⁷37 Steve AV, Kevin RF, James GK 3rd. Left ventricular thrombus in the absence of detectable heart disease. Chest. 1989;96(2):426-7. http://doi.org/10.1378/chest.96.2.426. PMid:2752829. http://doi.org/10.1378/chest.96.2.426...	Apical	3.62.91.1 (after excision)	Normal
Lew et al., 1983³⁸38 Lew AS, Federman J, Harper RW, et al. Operative removal of mobile pedunculated left ventricular thrombus detected by 2-dimensional echocardiography. Am J Cardiol. 1983;52(8):1148-9. http://doi.org/10.1016/0002-9149(83)90554-4. PMid:6637840. http://doi.org/10.1016/0002-9149(83)9055...	Apical	1.5	LV dilatation and septal hypokinesia.
Chamsi-Pasha et al., 2009³⁹39 Chamsi-Pasha MA, Anwar AM, Nosir YF, Chamsi-Pasha H. Hanging by a thread" left ventricular thrombus in an asymptomatic soldier. Saudi Med J. 2009;30(3):436-8. PMid:19271079.	Apical (apical septal)	1.5*2.7	LVEF 35%, global hypokinesia, and mild mitral regurgitation.
Early et al., 2001⁴⁰40 Early GL, Ballenger M, Hannah H 3rd, Roberts SR. Simplified method of left ventricular thrombectomy. Ann Thorac Surg. 2001;72(3):953-4. http://doi.org/10.1016/S0003-4975(00)02607-2. PMid:11565702. http://doi.org/10.1016/S0003-4975(00)026...	Apical	2*2	LVEF 25% and akinetic apex
Wohlfarter et al., 1991⁴¹41 Wohlfarter T, Hopferwieser T, Schwaighofer H, et al. An idiopathic floating left-ventricular thrombus. Dtsch Med Wochenschr. 1991;116(21):808-11. http://doi.org/10.1055/s-2008-1063682. PMid:2032531. http://doi.org/10.1055/s-2008-1063682...	Septum	3.5*2	NR
Palazzuoli et al., 1994⁴²42 Palazzuoli V, Mondillo S, D’Aprile N, Faglia S, Palazzuoli A. Heparin treatment and resolution of left ventricular thrombosis. Int J Cardiol. 1994;43(3):338-40. http://doi.org/10.1016/0167-5273(94)90217-8. PMid:8181893. http://doi.org/10.1016/0167-5273(94)9021...	Apical	1.5 at the longest diameter	NR
Jeon et al., 2012⁴³43 Jeon GJ, Song BG, Park YH, Kang GH, Chun WJ, Oh JH. Acute stroke and limb ischemia secondary to catastrophic massive intracardiac thrombus in a 40-year-old patient with dilated cardiomyopathy. Cardiol Res. 2012;3(1):37-40. http://doi.org/10.4021/cr142w. PMid:28357023. http://doi.org/10.4021/cr142w...	Apical	4.3*4.2	Global systolic dysfunction with LVEF 19% and dilated LV (6.5 cm).
Chirillo et al., 1996⁴⁴44 Chirillo F, Furlanetto A, Bruni A, Martines M, Stritoni P. Atypical electromechanical dissociation in a patient with recurrent pulmonary embolism. Chest. 1996;109(2):562-3. http://doi.org/10.1378/chest.109.2.562. PMid:8620738. http://doi.org/10.1378/chest.109.2.562...	Apical	10 at the longest dimension.	NR
DeWitt et al., 1988⁴⁵45 DeWitt LD, Pessin MS, Pandian NG, Paulker SG, Sonnenberg FA, Caplan LR. Benign disappearance of ventricular thrombus after embolic stroke. A case report. Stroke. 1988;19(3):393-6. http://doi.org/10.1161/01.STR.19.3.393. PMid:3354027. http://doi.org/10.1161/01.STR.19.3.393...	Apical	2*2.5	Normal
Hwang et al., 1985⁴⁶46 Hwang MH, Pacold I, Loeb HS. Acute anterior myocardial infarction complicated by mural thrombus and peripheral thromboembolism despite anticoagulation. Cathet Cardiovasc Diagn. 1985;11(4):417-22. http://doi.org/10.1002/ccd.1810110411. PMid:4042158. http://doi.org/10.1002/ccd.1810110411...	Apical	4 to 5	LVEF 26% and anterior apical aneurysm.
Çil et al., 2013⁴⁷47 Çil H, Yavuz C, Atilgan ZA, Gunduz E, Soydinc S. Complete resolution of the left ventricular pedunculated thrombus with tirofiban infusion in a patient with severe left ventricular dysfunction. Hong Kong J Emerg Med. 2013;20(5):305-8. http://doi.org/10.1177/102490791302000508. http://doi.org/10.1177/10249079130200050...	Apical (apical septal)	4*1.1	Left ventricle dysfunction (LVEF 26%) and apical aneurysm
Seitz et al., 2012⁴⁸48 Seitz MJ, McLeod MK, O’Keefe MD, Seah PW. A rare cause of Takotsubo cardiomyopathy related left ventricular apical thrombus requiring surgery. Heart Lung Circ. 2012;21(4):245-6. http://doi.org/10.1016/j.hlc.2011.07.004. PMid:21840755. http://doi.org/10.1016/j.hlc.2011.07.004...	Apical (apical inferior)	2.81.6 (31.5)	Left ventricle dysfunction with apical to mid-anterior hypokinesia.
Manasrah et al., 2022⁴⁹49 Manasrah N, Abdel-Qader A, Al Sbihi A, et al. Left ventricular thrombus formation in a structurally and functionally normal heart: a case report and literature review. J Investig Med High Impact Case Rep. 2022;10:23247096221101852. http://doi.org/10.1177/23247096221101852. PMid:35619244. http://doi.org/10.1177/23247096221101852...	Apical	Apical thrombus measuring 1.81.2 (2.32.1 by TEE at the anterolateral wall) and 1*0.5 (Apex)	Normal LV function with no segmental wall motion
Jeganathan and Ralph‐Edwards, 2011⁵⁰50 Jeganathan R, Ralph‐Edwards A. Left apical pedunculated thrombus with normal ventricular function mimicking an intracardiac tumor. J Card Surg. 2011;26(6):614-6. http://doi.org/10.1111/j.1540-8191.2011.01304.x. PMid:21951172. http://doi.org/10.1111/j.1540-8191.2011....	Apical	3*1	Normal
Erkal et al., 2017⁵¹51 Erkal Z, Bayar N, Arslan Ş. A case of thrombus formation in a patient with preserved left ventricle ejection fraction and development of peripheral embolization. Cyprus J Med Sci. 2017;2(2):38-9. http://doi.org/10.5152/cjms.2017.158. http://doi.org/10.5152/cjms.2017.158...	Septum	1.3*1.1	LVEF 65%
Maruri-Sánchez et al., 2019⁵²52 Maruri-Sánchez R, Diego-Nieto G, Monguió-Santín ME, Calle-Valda CM, Reyes-Copa G, Alfonso F. An intraventricular thrombus of unknown origin. Arch Cardiol Mex. 2019;89(3):267-9. PMid:31967595.	Septum	1.6*1.7	Normal (LVEF 60% with no regional wall motion)
Muller et al., 1996⁵³53 Müller S, Bartel T, Laube H. Left ventricular thrombus after pregnancy: choice of surgical access using dynamic three‐dimensional echocardiography. Echocardiography. 1996;13(3):293-6. http://doi.org/10.1111/j.1540-8175.1996.tb00899.x. PMid:11442934. http://doi.org/10.1111/j.1540-8175.1996....	Apical	4*2	Normal LV function
Lin et al., 2004⁵⁴54 Lin CP, Tsai FC, Chu PH, et al. Acute myocardial infarction in a young man complicated with left ventricular thrombi. Jpn Heart J. 2004;45(6):1029-35. http://doi.org/10.1536/jhj.45.1029. PMid:15655278. http://doi.org/10.1536/jhj.45.1029...	Between the septum and inferior wall close to the LVOT	1. 32 (32*2)	Normal
	Between the septum and inferior wall close to the LVOT	2. 11 (11*0.5)	Normal
Kuroki and Murakami, 2012⁵⁵55 Kuroki K, Murakami T. Thoracoscopy-assisted removal of left ventricular thrombus via minithoracotomy. Asian Cardiovasc Thorac Ann. 2012;20(1):77-9. http://doi.org/10.1177/0218492311424466. PMid:22371951. http://doi.org/10.1177/0218492311424466...	Apical	1. 1.51.41.3	Apical and anteroseptal wall motion and mild mitral regurgitation
	Apical	2. 0.30.20.1
Rao et al., 1990⁵⁶56 Rao PV, Roussak JB, Hershman MJ, Venn GE, Taylor KM. An unusual left ventricular mass. J R Soc Med. 1990;83(10):650-1. http://doi.org/10.1177/014107689008301019. PMid:2286968. http://doi.org/10.1177/01410768900830101...	Apical	NR	On day 2: mid and apical anterior akinesia
Zaikokuji et al., 2018⁵⁷57 Zaikokuji K, Sawazaki M, Tomari S, Uemura T. Transmitral thrombectomy to treat a patient with Takotsubo cardiomyopathy. Asian Cardiovasc Thorac Ann. 2018;26(3):236-8. http://doi.org/10.1177/0218492317729618. PMid:28870088. http://doi.org/10.1177/0218492317729618...	Apical	NR	Highly mobile, pedunculated mass arising from the left ventricular apex and protruding into the mitral orifice
Ho et al., 2008⁵⁸58 Ho JK, Dhamija N, Yezbick A, Mahajan A, Marijic J. Left ventricular mass: intraoperative transesophageal echocardiography for evaluation and management. Anesth Analg. 2008;107(4):1153-4. http://doi.org/10.1213/ane.0b013e3181806681. PMid:18806017. http://doi.org/10.1213/ane.0b013e3181806...	Apical	1.91.8 (decreased to 1.81.1 on the 5^th day but became more mobile)	LVEF 42.1%; akinetic apical and mid segments
	Apical	2.5*1.5	LVEF 45%; apical anterior dyskinesia; apical septal, inferior, and lateral hypokinesia.

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.