Free floating thrombus in the right atrium causing massive pulmonary embolism

Emergency Department Focused Bedside Echocardiography in Massive Pulmonary Embolism

“…Several prior case reports have documented echocardiographic findings leading to a diagnosis of PE in the ED or intensive care unit (1)(2)(3)(4)(5)(6)(7)(8)(9). To our knowledge, none of these echocardiograms was performed and interpreted by an emergency physician and guided thrombolytic Streaming videos: Two brief real-time ultrasound clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem.…”

Right Heart Thrombus-in-Transit: Detection and Migration during Transthoracic Echocardiography – Case Report

“…Tais taxas são substancialmente maiores que as taxas de mortalidade de 8% a 10% da TEP em geral 11. Nos pacientes com embolia pulmonar, a identificação de trombos nas câmaras direitas tem sido referida em 7% a 18% dos casos 1,12,13 . Devido à característica instável dos coágulos, que podem migrar a qualquer momento [1][2][3] , a realização de estudos ecocardiográficos mais frequentes levou ao aumento do seu reconhecimento em pacientes em TEP maciço ou submaciço 5 -7 . No entanto, só raramente, como em nosso caso, o momento da migração do trombo através das câmaras direitas para as artérias pulmonares pode ser evidenciado.…”

“…Geralmente, trombo em trânsito no coração direito (TTCD) está em trânsito das veias profundas dos membros inferiores para as artérias pulmonares e são relativamente instáveis [1][2][3] . Durante este processo, o trombo migratório pode levar a tromboembolia pulmonar (TEP) dentro de 24 horas 3 .…”

Right Heart Thrombus

“…The combination of a right atrial clot and a PFO could lead to the paradoxical embolization of the arterial circulation, thus increasing the urgency for prompt treatment. Existing published reports differ in their recommendations for treatment by advocating surgical removal, 3,8,9,10,15,[19][20][21][22][23][24][25][26][27][28][29][30][31] administration of thrombolytic agents, 9,[32][33][34][35][36][37][38][39][40][41][42][43] anticoagulation therapy with heparin, 9,44,45 or using interventional percutaneous retrieval techniques [46][47][48][49][50][51][52] (Table 2). 14 The overall mortality rate in patients with RHThIT has been reported as 28% to 44% with mortality rates in untreated patients of 100% in the English literature.…”