Abstract
A 43-year-old male with history of pulmonary embolism defaulted on anti-coagulation
and presented with recurrent massive pulmonary embolism. Echocardiography revealed
a serpiginous freely floating right atrial thrombus prolapsing through the tricuspid
valve into the right ventricle. Thrombus was also seen crossing the interatrial septum
into the left atrium and prolapsing into the left ventricle. Right-sided chambers
were dilated with right ventricular dysfunction. Left ventricle was functioning normally.
After evaluation by the pulmonary embolism response team, thrombolysis was done with
alteplase which resulted in dramatic improvement of the symptoms and complete resolution
of the intra-cardiac thrombus. Regular follow-up and counselling are advised henceforth
to ensure drug compliance.
Learning objectives
- 1.In patients with right heart thrombus crossing an intracardiac communication into left-sided chambers carries an additional risk.
- 2.Pulmonary embolism response team is essential for clinical decision-making.
- 3.Echocardiography plays a critical role to diagnose and assess the extent of the intracardiac thrombus and ventricular function.
- 4.On computed tomography, right ventricular (RV)/left ventricular diameter ratio of >0.9 and the presence of septal bowing signifies the presence of RV strain.
- 5.Adequate counselling ensuring patient compliance and regular follow up is of utmost importance.
Keywords
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Article info
Publication history
Published online: May 24, 2022
Accepted:
April 20,
2022
Received in revised form:
April 14,
2022
Received:
February 23,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.
