Apical densities
| View | Apical views with the focus and depth set for the near field; PSAX at the apical third (transducer down an interspace and lateral); colour Doppler with a low scale; UEA when uncertain. |
|---|---|
| Timing | Assess through the cycle: a true structure moves with the wall, clutter does not. |
| Caliper / trace | Describe location, attachment, mobility and the contractility of the adjacent segments; with UEA a thrombus is a black filling defect. |
Correct example
A density that moves with the apex, respects the endocardial border and sits over hypocontractile segments is likely a thrombus; near-field clutter is unaffected by wall motion and appears to pass through the wall. When uncertain, low-scale colour Doppler, another plane, or UEA is used to confirm or refute it.
Common error
Calling near-field clutter a thrombus, or dismissing a true apical mass because the apex was foreshortened or not specifically imaged at the apical PSAX level.
Effect on interpretation
The differential is visual, not an automated diagnosis: thrombus implies anticoagulation decisions, so an uncertain apical density should be reported as uncertain with the confirmatory step taken (UEA, CT or CMR) rather than resolved by assumption.
Why
Near-field clutter arises from reverberation close to the transducer (previously attributed to transducer ringing); harmonic imaging reduces it, and contrast fills the cavity so a real mass appears as a filling defect while swirling may occur over an akinetic apex.