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Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome

View Article: PubMed Central - PubMed

ABSTRACT

Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4–18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. A 79-year-old woman, with a history of recent total hysterectomy with adnexectomy and a Wells procedure, presented to the emergency department following an episode of syncope. Computed tomography revealed bilateral PE and the presence of a right atrial thrombus. Transthoracic echocardiography demonstrated a free-floating type A thrombus in the right atrium, protruding into the right ventricle, and signs of pulmonary hypertension and right ventricle dysfunction. Considering the recent surgery and clinical stability, treatment with heparin alone was decided. Subsequent clinical improvement was observed and echocardiographic follow-up revealed complete thrombus dissolution and complete recovery of right ventricle function. Most authors recommend treatment of PE with RHT with thrombolysis or embolectomy followed by anticoagulation, although evidence is scarce. Individual risk of hemorrhage and operatory-related mortality should be taken into account when defining the treatment strategy especially when benefit is not firmly established.

No MeSH data available.


Related in: MedlinePlus

Transthoracic echocardiography apical view showing a mobile thrombus in the right atrium in systole (white arrow).
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fig3: Transthoracic echocardiography apical view showing a mobile thrombus in the right atrium in systole (white arrow).

Mentions: Transthoracic echocardiography documented a big worm-like mass floating in the right atrium, protruding through the tricuspid valve into the right ventricle in diastole (see video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/9092576). Severe dilatation of the right heart chambers (right ventricle: 41 mm), significant tricuspid regurgitation, and moderate pulmonary hypertension (estimated pulmonary artery systolic pressure: 58 mmHg) were also documented (Figures 3 and 4).


Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome
Transthoracic echocardiography apical view showing a mobile thrombus in the right atrium in systole (white arrow).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392407&req=5

fig3: Transthoracic echocardiography apical view showing a mobile thrombus in the right atrium in systole (white arrow).
Mentions: Transthoracic echocardiography documented a big worm-like mass floating in the right atrium, protruding through the tricuspid valve into the right ventricle in diastole (see video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/9092576). Severe dilatation of the right heart chambers (right ventricle: 41 mm), significant tricuspid regurgitation, and moderate pulmonary hypertension (estimated pulmonary artery systolic pressure: 58 mmHg) were also documented (Figures 3 and 4).

View Article: PubMed Central - PubMed

ABSTRACT

Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4–18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. A 79-year-old woman, with a history of recent total hysterectomy with adnexectomy and a Wells procedure, presented to the emergency department following an episode of syncope. Computed tomography revealed bilateral PE and the presence of a right atrial thrombus. Transthoracic echocardiography demonstrated a free-floating type A thrombus in the right atrium, protruding into the right ventricle, and signs of pulmonary hypertension and right ventricle dysfunction. Considering the recent surgery and clinical stability, treatment with heparin alone was decided. Subsequent clinical improvement was observed and echocardiographic follow-up revealed complete thrombus dissolution and complete recovery of right ventricle function. Most authors recommend treatment of PE with RHT with thrombolysis or embolectomy followed by anticoagulation, although evidence is scarce. Individual risk of hemorrhage and operatory-related mortality should be taken into account when defining the treatment strategy especially when benefit is not firmly established.

No MeSH data available.


Related in: MedlinePlus