Submassive pulmonary embolism with a right heart thrombus

Abstract

A 49-year-old woman presented to the hospital with shortness of breath 2 weeks after a left total hip replacement. She was found to have a submassive pulmonary embolism (PE), with her case complicated by the detection of a large mobile clot in transit extending through a patent foramen ovale between the right and left atria. The presence of this free-floating right heart thrombus (FFRHT) increases her risks of stroke and mortality, yet the optimal approach to her treatment was unclear. Ultimately, intravenous tissue plasminogen activator was administered with resolution of the clot. Treatment was complicated by haemodynamically insignificant bleeding at the site of recent surgery. Herein, we further discuss the implications and treatment options for patients with an FFRHT in the setting of an acute PE.

Clot-in-transit: A ticking time bomb in the heart with serious consequences

“…1 The thrombus could be located in the right atrium, right ventricle (RV), superior vena cava, inferior vena cava, patent foramen ovale (PFO) or septal defect. [2][3][4][5][6] CITs are highly mobile serpiginous masses which are free floating or have thin attachments, and can readily embolize into the pulmonary circulation with disastrous consequences. We describe two cases of CIT incidentally diagnosed by bedside point-of-care ultrasonography (POCUS) performed by the Intensivist, and both CITs dislodged quickly into the pulmonary vasculature with serious manifestations.…”