Left ventricular thrombus or pseudothrombus? A rare cardiac CT artifact

A 39 year-old man with idiopathic dilated cardiomyopathy and severe left ventricular (LV) systolic impairment (ejection fraction 20%) underwent cardiac computed tomography (CT) to exclude pulmonary vein stenosis for new-onset dyspnoea post-pulmonary vein isolation ablation for paroxysmal atrial fibrillation. During the CT, the patient was in atrial flutter with fast ventricular response (86–120 beats/min). Given the severe LV impairment, no intravenous beta-blocker was administered and end-systolic ECG-gating (35% of R-R interval) was employed with 320-multidector array system (Aquilion one, Toshiba) after 73 mL 400 mg iodine/mL (Iomeron 400, Bracco) and 30 mL 0.9% sodium chloride at 4 mL/s via 18-gauge antecubital fossa venflon.

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