The next example shows echogenic thrombi in a 4-chamber view (video on the left side) from a patient with a highly reduced systolic function (ejection fraction below 25%). The thrombi can be displayed with a full volume data set. By enhancement of tissue transparence only the echogenic thrombi are depicted and the surrounding tissue back scatter is suppressed (video on the right side). The thrombi are viewed from the middle of the left ventricle towards the apex. Five thrombi can be differentiated. To enlarge a video click on the little white square in the bottom right corner of the flash player. To return to the text, click again on the square.

After injection of contrast bubbles suppression of the intense back scatter of the echogenic thrombi is not satisfying with the frequency 1.5/3.0 MHz. Thrombi are still depicted in a grey color (video on the left side). A further reduction of mechanical index has not been helpful, although this is – in principle – the best way to solve the problem. After changing the frequency from 1.5/3.0 MHz to 2.0 MHz, the remaining back scatter of the thrombi is fully suppressed and the thrombi appear as a black contrast free area in the left apex (3 chamber view, video on the right side)