What tissue characteristics can endothelialized thrombi exhibit as seen on 2D echo?

Endothelialized thrombi can exhibit characteristics that resemble myocardium on 2D echocardiography. This occurs because, as thrombi are incorporated into the heart tissue, they undergo changes that lead to cellular proliferation, including an increase in connective tissue and the formation of new endothelial lining over the thrombus. The echogenicity and texture can mimic that of myocardium due to these alterations, particularly if the thrombus becomes organized and receives a blood supply.

This resemblance to myocardium can assist sonographers in distinguishing these thrombi from other masses, as their appearance may not always be typical of a conventional thrombus, which may be more hypoechoic and less homogeneous. Recognizing this feature is important for proper diagnostic interpretation and management of cardiac conditions involving such thrombi.