Conclusion: Most patients in whom AMT develops in the absence of underlying aortic disease have underlying coagulation disorders. Anticoagulation therapy alone allows resolution of AMT, with surgical intervention reserved for management of end organ ischemia from thrombus embolization.

Mural thrombi are thrombi that attach to the wall of a blood vessel and cardiac chamber. Mural thrombus occurrence in a normal or minimally atherosclerotic vessel is a rare entity in the absence of a hypercoagulative state or inflammatory, infectious, or familial aortic ailments.

A mural thrombus is an organizing blood clot attached to the wall of a blood vessel or the endocardium of the heart. It is composed of platelets, fibrin, and trapped red and white blood cells. As mural thrombi organize, they form characteristic alternating layers of fibrin and trapped cells, called lines of Zahn.

Left ventricular (LV) thrombus may develop after acute myocardial infarction (MI) and occurs most often with a large, anterior ST-elevation MI (STEMI). However, the use of reperfusion therapies, including percutaneous coronary intervention and fibrinolysis, has significantly reduced the risk.

Anticoagulation is an effective treatment for aortic mural thrombi. J Vasc Surg 2002;36:713-9.

A thrombus is a blood clot that forms in a vein. An embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass. When this happens, the blood flow is stopped by the embolus. An embolus is often a small piece of a blood clot that breaks off (thromboembolus).

Mural thrombi can be seen in large vessels such as the heart and aorta and can restrict blood flow. They are mostly located in the descending aorta, and less commonly, in the aortic arch or the abdominal aorta.

Intraluminal thrombus (ILT) thickness (red arrow) is defined as the distance from the ventral aneurysm wall to the aortic lumen in the anteroposterior direction on the orthogonal slices.

Between 2011 and 2018, the authors reviewed 90,065 consecutive echocardiogram reports to identify patients with confirmed LV thrombus. Major adverse cardiac events (MACE), including death, stroke, myocardial infarction, or acute peripheral artery embolism, were assessed, as were major bleeding and all-cause mortality.

Computed tomography is the most common imaging to show these findings (as in the images above). Mural thrombi can also be noted during echocardiography, most likely in the ascending aorta. In contrast, there are patients who present with symptoms. The most common clinical presentation is distal embolization of parts of the clot.

They are dangerous and can break loose to form emboli. A mural thrombus can be symptomatic or asymptomatic; they are mainly formed in the aorta. They can be diagnosed with imaging techniques such as CT scan, transesophageal echocardiography, and magnetic resonance imaging.

Anticoagulants should be considered in patients in whom mural thrombi develop as a complication of their infarction. Patients with congestive cardiomyopathy should be considered for long-term anticoagulation. These recommendations are all tempered by the realization that the use of anticoagulant therapy is not without its own risks.