Pediatric Radiology

, Volume 48, Issue 5, pp 722–731 | Cite as

Magnetic resonance imaging of cardiovascular thrombi in children

  • Pablo Caro-Dominguez
  • Shi-Joon Yoo
  • Mike Seed
  • Lars Grosse-Wortmann
Pictorial Essay


Cardiovascular thrombosis is rare in children and usually occurs in the presence of predisposing conditions, such as indwelling vascular catheters, tumors, aneurysms, ventricular dysfunction, or after surgery. Clots can occur in the cardiac chambers, arteries or veins, or inside conduits. Detection of thrombi is feasible with a variety of magnetic resonance imaging (MRI) techniques, including unenhanced methods but also contrast-enhanced MR angiography. In this essay we illustrate the MRI appearance of cardiovascular thrombosis in children and suggest an imaging protocol based on our clinical experience.


Cardiovascular Children Heart Magnetic resonance imaging Thrombus 


Compliance with ethical standards

Conflicts of interest


Supplementary material

247_2017_4011_MOESM1_ESM.avi (4.9 mb)
ESM 1 (AVI 4971 kb)
247_2017_4011_MOESM2_ESM.avi (11.1 mb)
ESM 2 (AVI 11402 kb)
247_2017_4011_MOESM3_ESM.avi (3.9 mb)
ESM 3 (AVI 4041 kb)


  1. 1.
    Virchow R (1856) Thrombose und Embolie: Gefässentzündung und septische Infektion. [Thrombosis and embolism: vasculitis and septic infection] In: Virchow R (ed) Gesammelte Abhandlungen zur wissenschaftlichen Medicin [Complete essays on academic medicine]. Meidinger, Frankfurt, pp 219–732Google Scholar
  2. 2.
    Andrew M (1995) Developmental hemostasis: relevance to thromboembolic complications in pediatric patients. Thromb Haemost 74:415–425PubMedGoogle Scholar
  3. 3.
    Biss TT, Brandao LR, Kahr WH et al (2008) Clinical features and outcome of pulmonary embolism in children. Br J Haematol 142:808–818CrossRefPubMedGoogle Scholar
  4. 4.
    Thacker PG, Lee EY (2015) Pulmonary embolism in children. AJR Am J Roentgenol 204:1278–1288CrossRefPubMedGoogle Scholar
  5. 5.
    Mollet NR, Dymarkowski S, Volders W et al (2002) Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease. Circulation 106:2873–2876CrossRefPubMedGoogle Scholar
  6. 6.
    Barkhausen J, Hunold P, Eggebrecht H et al (2002) Detection and characterization of intracardiac thrombi on MR imaging. AJR Am J Roentgenol 179:1539–1544CrossRefPubMedGoogle Scholar
  7. 7.
    Ohyama H, Hosomi N, Takahashi T et al (2003) Comparison of magnetic resonance imaging and transesophageal echocardiography in detection of thrombus in the left atrial appendage. Stroke 34:2436–2439CrossRefPubMedGoogle Scholar
  8. 8.
    Mohrs O, Nowak B, Petersen SE et al (2006) Thrombus detection in the left atrial appendage using contrast-enhanced MRI: a pilot study. AJR Am J Roentgenol 186:198–205CrossRefPubMedGoogle Scholar
  9. 9.
    Ridgway JP (2010) Cardiovascular magnetic resonance physics for clinicians: part I. J Cardiovasc Magn Reson 12:71CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Paydarfar D, Krieger D, Dib N et al (2001) In vivo magnetic resonance imaging and surgical histopathology of intracardiac masses: distinct features of subacute thrombi. Cardiology 95:40–47CrossRefPubMedGoogle Scholar
  11. 11.
    Sparrow PJ, Kurian JB, Jones TR, Sivananthan MU (2005) MR imaging of cardiac tumors. Radiographics 25:1255–1276CrossRefPubMedGoogle Scholar
  12. 12.
    Mendichovszky IA, Priest AN, Bowden DJ et al (2017) Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis: a feasibility study. Eur Radiol 27:2326–2332CrossRefPubMedGoogle Scholar
  13. 13.
    Compton GL, Grosse-Wortmann L (2014) Kawasaki disease on CMRI. Accessed 28 Sep 2017
  14. 14.
    Jansen CH, Perera D, Makowski MR et al (2011) Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 124:416–424CrossRefPubMedGoogle Scholar
  15. 15.
    Suzuki A, Takemura A, Inaba R et al (2006) Magnetic resonance coronary angiography to evaluate coronary arterial lesions in patients with Kawasaki disease. Cardiol Young 16:563–571CrossRefPubMedGoogle Scholar
  16. 16.
    Greil GF, Seeger A, Miller S et al (2007) Coronary magnetic resonance angiography and vessel wall imaging in children with Kawasaki disease. Pediatr Radiol 37:666–673CrossRefPubMedGoogle Scholar
  17. 17.
    Vaideeswar P, Deshpande JR (2013) Pathology of Takayasu arteritis: a brief review. Ann Pediatr Cardiol 6:52–58CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ohno Y, Higashino T, Takenaka D et al (2004) MR angiography with sensitivity encoding (SENSE) for suspected pulmonary embolism: comparison with MDCT and ventilation-perfusion scintigraphy. AJR Am J Roentgenol 183:91–98CrossRefPubMedGoogle Scholar
  19. 19.
    Stein PD, Chenevert TL, Fowler SE et al (2010) Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med 152:434–443CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    O’Neill A, Ridge C, Cury RC et al (2010) Cardiovascular flashlight: detection of cardiac tumor-surface thrombus — utilization of cardiac magnetic resonance imaging avascular tissue nulling sequence. Eur Heart J 31:1421CrossRefPubMedGoogle Scholar
  21. 21.
    Johnson JT, Robinson JD, Deng J, Rigsby CK (2016) Combined blood pool and extracellular contrast agents for pediatric and young adult cardiovascular magnetic resonance imaging. Pediatr Radiol 46:1822–1830CrossRefPubMedGoogle Scholar
  22. 22.
    Rigsby CK, Popescu AR, Nelson P et al (2015) Safety of blood pool contrast agent administration in children and young adults. AJR Am J Roentgenol 205:1114–1120CrossRefPubMedGoogle Scholar
  23. 23.
    Vasanawala SS, Nguyen KL, Hope MD et al (2016) Safety and technique of ferumoxytol administration for MRI. Magn Reson Med 75:2107–2111CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Tandon A, James L, Henningsson M et al (2016) A clinical combined gadobutrol bolus and slow infusion protocol enabling angiography, inversion recovery whole heart, and late gadolinium enhancement imaging in a single study. J Cardiovasc Magn Reson 18:66CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Shapiro MA, Johnson M, Feinstein SB (2002) A retrospective experience of right atrial and superior vena cava thrombi diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr 15:76–79CrossRefPubMedGoogle Scholar
  26. 26.
    Manlhiot C, Menjak I, Brandao L et al (2011) Risk, clinical features, and outcomes of thrombosis associated with pediatric cardiac surgery. Circulation 124:1511–1519CrossRefPubMedGoogle Scholar
  27. 27.
    Nowak-Gottl U, Kosch A, Schlegel N et al (2002) Thromboembolism in children. Curr Opin Hematol 9:448–453CrossRefPubMedGoogle Scholar
  28. 28.
    Kluge A, Luboldt W, Bachmann G (2006) Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol 187:W7–W14CrossRefPubMedGoogle Scholar
  29. 29.
    de Divitiis M, Omran H, Rabahieh R et al (1999) Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors. Am J Cardiol 84:1023–1028CrossRefPubMedGoogle Scholar
  30. 30.
    Turhan S, Özcann ÖU, Erol C (2013) Imaging of intracardiac thrombus. Cor et Vasa 55:176–183CrossRefGoogle Scholar
  31. 31.
    Tan CN, Fraser AG (2007) Transesophageal echocardiography and cardiovascular sources of embolism: implications for perioperative management. Anesthesiology 107:333–346CrossRefPubMedGoogle Scholar
  32. 32.
    Celermajer DS, Sholler GF, Howman-Giles R, Celermajer JM (1991) Myocardial infarction in childhood: clinical analysis of 17 cases and medium term follow up of survivors. Br Heart J 65:332–336CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Kato H, Sugimura T, Akagi T (1996) Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 94:1379–1385CrossRefPubMedGoogle Scholar
  34. 34.
    Qureshi SA (2006) Coronary arterial fistulas. Orphanet J Rare Dis 1:51CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Tomasson G, Monach PA, Merkel PA (2009) Thromboembolic disease in vasculitis. Curr Opin Rheumatol 21:41–46CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Pablo Caro-Dominguez
    • 1
    • 2
  • Shi-Joon Yoo
    • 1
    • 3
  • Mike Seed
    • 1
    • 3
  • Lars Grosse-Wortmann
    • 1
    • 3
  1. 1.Department of Diagnostic Imaging, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  2. 2.Department of Diagnostic ImagingHospital VIAMED Santa Angela de la Cruz, Health Time groupSevillaSpain
  3. 3.Division of Cardiology, Department of Paediatrics, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada

Personalised recommendations