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Case Reports
. 2018 Apr-Jun;28(2):146-149.
doi: 10.4103/jcecho.jcecho_64_17.

Free-Floating Right Heart Thrombus with Acute Massive Pulmonary Embolism: A Case Report and Review of the Literature

Fida Charif  1   2 , Mohamad Jihad Mansour  1   3 , Righab Hamdan  4 , Claudette Najjar  4 , Pierre Nassar  4 , Mohamad Issa  5 , Elie Chammas  1   3 , Mohamad Saab  6
Affiliations
Case Reports

Free-Floating Right Heart Thrombus with Acute Massive Pulmonary Embolism: A Case Report and Review of the Literature

Fida Charif et al. J Cardiovasc Echogr. 2018 Apr-Jun.

Abstract

Free-floating right heart thrombus (RHT) is an extreme medical emergency in the context of acute massive pulmonary embolism (PE). Despite the advances in early diagnosis, the management is still very debatable due to lack of consensus. We reported the case of a 66-year-old male, with a history of moderate renal dysfunction and dilated cardiomyopathy, who presented to the emergency department for acute dyspnea. His angiographic magnetic resonance imaging revealed bilateral extensive PE. Transthoracic echocardiography showed RHT with moderate right ventricular dysfunction and pulmonary hypertension. Venous Doppler of the lower extremities noted the presence of a floating clot in the right common femoral vein. The patient was managed successfully by thrombolytic therapy with tenecteplase. To the best of our knowledge, this is the first case report of RHT and PE from Lebanon. Published cases from Middle Eastern countries are scarse.

Keywords: Echocardiography; pulmonary embolism; right heart thrombus; thrombectomy; thrombolysis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transthoracic echocardiogram subcostal view showing a serpiginous highly mobile right atrial thrombus (black arrowheads)
Figure 2
Figure 2
Chest magnetic resonance imaging showing embolism in the right and left main pulmonary arteries (white arrows)
Figure 3
Figure 3
Chest magnetic resonance imaging showing marked resorption of the right and left main pulmonary artery embolism (white arrows)
See this image and copyright information in PMC

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