Successful treatment of mobile right atrial thrombus and acute pulmonary embolism with intravenous tissue plasminogen activator

Abstract

An 89-year-old woman came with symptoms of progressively worsening dyspnoea at rest over the preceding week. She was normotensive, had elevated jugular venous pressure and clear lungs. ECG revealed atrial fibrillation with the rapid ventricular rate. Labs were significant for markedly elevated pro-brain natriuretic peptide of 43,000 pg/mL and troponin-T of 1 ng/mL. An urgent 2D echocardiogram was obtained, which revealed the severely dilated right atrium and a large linear mobile mass in the right atrium consistent with a thrombus. An emergent CT scan revealed multiple bilateral pulmonary emboli. She received intravenous tissue plasminogen activator. Repeat echocardiogram performed 6 h later showed no evidence of the right atrial thrombus. She was subsequently maintained on intravenous heparin and transitioned to Coumadin. Early recognition of this rare but potentially fatal complication is important as prompt treatment measures can help in preventing life-threatening complications of the right atrial thrombus

Point of care ultrasound in cardiac arrest: A case report of PE in PEA arrest

“…The use of thrombolytics also contributed to the rapid improvement in the overall clinical course. Our case report is in agreement with previous case reports of patients that have survived after both the diagnosis by ultrasound of right heart thrombus and treatment with thrombolysis [50,[64][65][66][67]. This case further supports the needs for a randomized controlled trial to better determine the best treatment option for right heart thrombus during cardiac arrest [14].…”