Free-Floating right heart thrombus with acute massive pulmonary embolism: A case report and review of the literature

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.

Right Heart Thrombus and Pulmonary Embolism in Patients with Life-Threatening Bleeding: Management of a Complex Condition

“…RHT mortality is about 28%, raising up to almost 100% in untreated patients [1]. Though some authors consider floating RHT as an in-transit pulmonary embolism, there is no consensus about the most appropriate management of this critical situation [2][3][4][5]. Therapeutic strategy should be decided according to patient's haemodynamic parameters, clinical data and bleeding risk [5].…”

“…Right heart thrombus (RHT) in transit is an uncommon situation, often concomitant with pulmonary embolism (PE), and associated with high mortality [1]. Increased use of echocardiography has allowed an easier detection of RHT; however, the optimal management of this condition remains controversial [2][3][4][5]. Herein, presenting a case of 82-year-old Caucasian man with subarachnoid bleeding, floating thrombus in right atrium, massive pulmonary embolism and Stanford B aortic dissection, we analyse the possible management of a difficult condition between thrombosis and bleeding risk.…”

Case Report: Successful revascularization in massive pulmonary embolism with a large protruding thrombus and dilated cardiomyopathy

“…Pulmonary embolism is a critical medical emergency. It can lead to rapid deterioration of hemodynamic condition with high mortality rate 10 . Pulmonary embolism usually arises from thrombus originating from the deep venous system in the inferior limb.…”

Management of a huge right atrial thrombus in a patient with multiple comorbidities

“…Floating right heart thrombi (RHT) probably represent an extreme medical emergency in the context of acute pulmonary embolism (APE) [ 1 ]. The prevalence of RHT in the setting of PE is 4–18% [ 2 ].…”