Right heart thrombus in patient with acute pulmonary embolism-a practice in hide-and-seek with guidelines

Abstract

Introduction. Right heart thrombus (RHT) are relatively rare phenomenon (4%) in patients with acute pulmonary embolism (PE) and in some reports is suggested that presence of RHT was associated with poor outcome. Optimal treatment of patients with PE and RHT are still controversial with no clear consensus. Case report. We presented 38-years old woman with symptoms of repeated chest pain and worsening dyspnea. Echocardiographically big thrombus floating in right atrium protruding through the tricuspid valve in right ventricle was noticed and massive bilateral pulmonary embolism was confirmed by computed tomography pulmonary angiogram (CTPA). According to CT and echocardiographic findings, clinical and hemodynamic instability thrombolytic therapy was immediately initiated with alteplase which resulted in excellent clinical outcome and with no adverse events at follow-up. Conclusion. This case demonstrates that management of patients with PE and RHT is very difficult and until weawaiting results of randomized clinical trials, the treatment of this patients should be based according to current guidelines in regard to their hemodynamic stability.