Obliterating left ventricular mural thrombosis.

Case Report A 64-year-old white man, blind since birth, considered himself well until March 1960. Because of progressive weakness, shortness of breath upon effort, and swelling of the ankles, he entered Episcopal Hospital on June 13, 1960. Cardiac therapy was intensified and left thoracentesis was done on several occasions. The fluid was serosanguineous in character. Pleural biopsy, with a Vim-Silverman needle, disclosed only fibrous tissue. He was discharged on July 18, 1960. Shortly thereafter, shortness of breath again increased, and ankle edema and left pleural effusion reappeared. He was re-admitted to Episcopal Hospital on August 17, 1960. Findings were similar to those previously observed. The blood pressure was 100/80 mm. Hg. The temperature was normal. There was bilateral optic atrophy. The jugular veins were slightly distended. The cardiac impulse was not palpable. Heart sounds were distant and normal in quality, rate, and rhythm. There were no murmurs. Signs of left pleural effusion were present. The abdomen was negative; the liver and spleen were not felt. There was moderate pitting edeama of the legs and feet. The hemoglobin and electrolytes were normal, the serologic tests for syphilis were negative, and the serum glutamic oxaloacetie transamninase was normal. Roentgenogram of the chest (fig. 1) revealed increased size of the cardiac silhouette, involving mainly the left ventricular salient. The upper border of the left ventricle tended to be concave anrd bulged laterally into the density produced by a left pleural effusion. On fluoroscopy, following removal of most of the pleural fluid, no pulsation could be seen over the left ventricle. There were faint pulsations of the other borders of the cardiac silhouette. There was no change in the cardiac silhouette with either the Mueller or Valsalva maneuver. There was no intracardiac calcification. The pulmonary vascular markings