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Floating right heart thrombus and massive pulmonary embolism

Summary

Right heart thrombi are a severe form of venous thromboembolic disease and justify diagnosis and treatment in emergency. Free-floating right heart thrombi are a rare phenomenon, generally diagnosed when echocardiography is performed in patients with suspected or proven pulmonary embolism, and have a dismal prognosis if not diagnosed and treated in a timely manner. In our case which presented and treated in December 2010, thrombolytic therapy was the treatment of choice, although other treatment options are available, including anticoagulation and embolectomy.

References

  1. Mularek-Kubzdela T, Grygier M, Grajek M, Cieslinski A. Right atrial thrombosis: a difficult diagnostic and therapeutic problem [in Polish]. Przegl Lek 1997; 54:515–519.

    CAS  PubMed  Google Scholar 

  2. Colletta M, Paoloni P, Ciliberti D, De Castro U, Capone P. Right atrial thrombosis and pulmonary embolism: role of echocardiography [in Italian]. Minerva Cardioangiol 1997; 45:439–442.

    CAS  PubMed  Google Scholar 

  3. Valenzuela García LF, Gallego García de Vinuesa P, Rodriguez Revuelta M, Calvo Jambrina R, Pavon R, Moreno Alba R, et al. Right atrial thrombus in transit: echocardiographic diagnosis preceding a pulmonary embolism by 72hours [in Spanish]. Rev Esp Cardiol 1999; 52:59–62.

    Article  Google Scholar 

  4. Chartier L, Béra J, Delomez M, Asseman P, Beregi JP, Bauchart JJ, et al. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation 1999; 99:2779–2783.

    Article  CAS  Google Scholar 

  5. Torbiki A, Galie N, Covezzoli A, Rossi E, Goldhaber S. Right heart thrombi in pulmonary embolism: results from the international cooperative pulmonary embolism registry. J Am Coll Cardiol 2003; 41:2245–2251.

    Article  Google Scholar 

  6. Shah CP, Thakur RK, Ip JH, Xie B, Guiraudon GM. Management of mobile right atrial thrombi: a therapeutic dilemma. J Card Surg 1996; 11:428–431.

    Article  CAS  Google Scholar 

  7. Chartier L, Bera J, Delomez M, Asseman P, Bereqi JP, Bauchart JJ, et al. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation 1999; 99:2779–2783.

    Article  CAS  Google Scholar 

  8. Janssens U, Breithardt OA, Greinacher A. Successful thrombolysis of right atrial and ventricle thrombi encircling a temporary pacemaker lead in a patient with heparin-induced thrombocytopenia type II. Pacing Clin Electro-physiol 1999; 22 (Pt1): 678–681.

    Article  CAS  Google Scholar 

  9. Olbrich K, Wiersbitzky M, Wacke W, Eichler P, Zinke H, Schwock M, et al. Atypical heparin-induced thrombocytopenia complicated by intracardiac thrombus, effectively treated with ultra-low-dose rt-PA lysis and recombinant hirudin. Blood Coagul Fibrinolysis 1998; 9:273–277.

    Article  CAS  Google Scholar 

  10. Cracowski JL, Tremel F, Baguet JP, Mallion JM. Thrombolysis of mobile right atrial thrombi following severe pulmonary embolism. Clin Cardiol 1999; 22:151–154.

    Article  CAS  Google Scholar 

  11. Aspesberro F, Beghetti M, Obensli I, Ozsahin H, Humbert J, Rimensberger PC. Local low-dose urokinase treatment of acquired intracardiac thrombi in preterm infants. Eur J Pediatr 1999; 158:698–701.

    Article  CAS  Google Scholar 

  12. Dufour C, Molinari A, Tasso L, De Caro E, Rimini A, Mori PG. Lysis of a right atrial thrombus of more than a week’s duration by high dose urokinase in a one-year-old child. Haematologica 1997; 82:357–359.

    CAS  PubMed  Google Scholar 

  13. Nani R, Novello P, Decastello M, Cavarzerani A, Sarpellon M. Right atrial thrombosis with concomitant thrombus attached to a central venous catheter. Clinical case [in Italian]. Minerva Anestesiol 1997; 63:209–212.

    CAS  PubMed  Google Scholar 

  14. Lepper W, Janssens U, Klues HG, Hanrath P. Successful lysis of mobile right heart and pulmonary artery thrombi: diagnosis and monitoring by transeso-phageal echocardiography [letter]. Eur Heart J 1996; 17:1603–1604.

    Article  CAS  Google Scholar 

  15. Torbicki A, Galié N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ. ICOPER study group. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 2003; 41:2245–2251.

    Article  Google Scholar 

  16. Ferrari E, Benhamou M, Berthier F, Baudouy M. Mobile thrombi of the right heart in pulmonary embolism: delayed disappearance after thrombolytic treatment. Chest 2005; 127:1051–1053.

    Article  Google Scholar 

  17. Huang SL, Chien CH, Chang YC. A floating thrombus of the right ventricle in severe massive pulmonary embolism. Am J Emerg Med 2008; 26:e1–e2.

    Article  Google Scholar 

  18. Torbicki A, Perrier A, Konstantinides S, Angnelli G, Galie N, Pruszczyk P. Guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and management of acute pulmonary embolism of the European Society of cardiology (ESC). Eur Heart J 2008; 29:2276–2315.

    Article  CAS  Google Scholar 

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Correspondence to Khalid Y. Tohamy.

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Tohamy, K.Y., Ali, I., Faris, M. et al. Floating right heart thrombus and massive pulmonary embolism. Egypt J Intern Med 24, 108–112 (2012). https://doi.org/10.7123/01.EJIM.0000422607.07704.63

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  • DOI: https://doi.org/10.7123/01.EJIM.0000422607.07704.63

Keywords

  • anticoagulation
  • embolectomy
  • pulmonary embolism
  • thrombi
  • thrombolytic therapy