Differential diagnosis of thrombosis and myxoma in unusual heart positions by dual-energy CT multiple parameter imaging: A case series

Rationale: Thrombus is the most common occupying lesion in the cardiac chambers, it is often distinguished from cardiac neoplastic occupations. Among them, the most common is cardiac myxoma, whose imaging manifestations are often confused with thrombus. However, the 2 types of lesions have different therapeutic strategies and are both potentially high-risk sources of embolism, so early differentiation between intracardiac thrombus and cardiac tumor is essential. In this study, we intend to investigate the value of dual-energy computed tomography (CT) in the differential diagnosis of cardiac thrombus and myxoma by retrospectively analyzing the dual-energy CT-related parameters of 2 cases of intracardiac thrombus and 1 case of cardiac myxoma.

Patient concerns: Three cases of masses located in uncommon areas of the heart with comparable imaging characteristics are presented in this study.

Diagnoses: Echocardiography revealed an isoechoic mass in the cardiac chambers, while CT scans showed a hypodense occupancy with varying morphologies. Postoperative pathology or follow-up after treatment confirmed 1 case as a right ventricular thrombus, another as a right atrial thrombus, and the third as a right ventricular myxoma.

Interventions: In this study, we conducted a retrospective analysis of dual-energy CT-related parameters in 2 cases of intracardiac thrombus and 1 case of cardiac myxoma.

Outcomes: Our findings indicate notable differences in the slopes of the energy spectral curves, mean iodine density, and effective atomic number between the intracardiac thrombus and myxoma cases.

Lessons: Drawing upon existing literature, we propose combining different quantitative analysis methodologies to create a more objective foundation for distinguishing between cardiac thrombosis and myxoma.