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Figure 5 (A) A computed tomographic scan of the chest with contrast demonstrating an intracardiac mass (white arrow) and a hypodense area in the lung parenchyma (yellow arrow). (B) Apical four-chamber view of the left ventricular (LV) apical mass (white arrow) and the mass extrinsic to the LV apex (yellow arrow). (C) The LV apical mass failed to enhance with contrast, whereas the extrinsic mass hyper-enhanced, relative to the myocardium, and demonstrated large vascular channels (yellow arrow). (D) There was no enhancement of the masses or adjacent myocardium after a high-mechanical index impulse destroyed the microbubbles. (E) The biopsy specimen of the extrinsic mass showed a well-differentiated adenocarcinoma with multiple vascular channels stained with CD34 antibody. Lacking pathologic correlation, the intracardiac mass was not included in the comparison of contrast perfusion with VAI and does not appear in Table 2. (F) Perfusion curves of video intensity over time demonstrated greater values for A and ß for the mass than for the adjacent myocardium and no increase in intensity from baseline for the intracardiac mass. The intracardiac mass was presumed to be a thrombus.