Submassive Pulmonary Embolism and Left Atrial Thrombus (original) (raw)
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Extensive Left Ventricular Thrombosis with Concomitant Pulmonary Embolism
Clinics and Practice
A 57-year-old non-obese female patient with a history of heavy smoking, chronic obstructive pulmonary disease and hypertension was admitted to the hospital as an emergency for acute hemoptysis and signs of congestive heart failure. To assess the source of hemoptysis, computed tomography (CT) pulmonary angiography was performed, which confirmed a bilateral pulmonary embolism of the apical branches. The routinely performed transthoracic echocardiography (TTE) revealed an enlarged left ventricle with severely reduced ejection fraction (EF = 25%) due to global hypokinesia and multiple, mobile, echogenic masses. To increase the diagnostic accuracy, real-time three-dimensional (Live 3D) imaging of the masses was added which described multiple left ventricular (LV) thrombi. Successful resolution of intraventricular thrombi was noticed after treatment with oral anticoagulant therapy (acenocumarol), despite the lack of regular INR control.
International Journal of Cardiology, 2008
The presence of a right-atrium thrombus is considered as an unusual form of thromboembolic disease, with a prevalence of 10-18%. Most of them are located in the right-atria. Its mortality is about 45%. Echocardiography is very important to detect them and to control the effectiveness of the treatment, which can be either conservative or surgical. We present a case of a man to show the importance of echocardiography in this pathological diagnosis, what is essential for a right-treatment.
Free-Floating Thrombi in the Right Atrium Causing Pulmonary Embolism
European Journal of Case Reports in Internal Medicine, 2014
A 74--year--old man presented to our Emergency Department with acute dyspnoea. His electrocardiogram showed atrial flutter with 2:1 block and a rate of 150 bpm. Initial investigations revealed a D--dimer level of 6.01 mg/dl. Based on the patient's complaints and the high D--dimer level, computed tomography pulmonary angiography was immediately performed. This showed no evidence of pulmonary embolism, but there were pneumatic changes in the right upper lung lobe. Antibiotics treatment was started with pipracillin/tazobactam, after which the patient's condition improved.
European Journal of Case Reports in Internal Medicine, 2015
Pulmonary embolism (PE) related to the presence of right heart thromboemboli entails a higher mortality rate than PE alone. Furthermore, right heart thromboemboli are often associated with deep venous thrombosis. The most effective therapy for haemodynamically stable patients remains unknown, although recent data suggest that thrombolytic therapy is associated with a better outcome. We describe the case of an 83-year-old woman, hospitalized with PE consequent to right heart thrombus-in-transit, in whom investigation revealed a concomitant deep venous thrombosis. She required thrombolysis, given the high mortality risk that is traditionally associated with this clinical entity. LEARNING POINTS • Pulmonary embolism secondary to right-sided cardiac thromboembolus entails a higher mortality rate than PE alone. • Echocardiography is useful for the rapid detection of cardiac thrombi in patients with suspected PE. • There is no consensus on the best therapeutic approach in this context, although there is some evidence that supports thrombolysis.
Imminent Pulmonary Embolism: A Fatal Mobile Right Atrial Thrombus
The International Journal of Cardiovascular Imaging, 2006
Right sided heart thrombi are infrequent and if they are mobile they may cause serious morbidity and mortality due to massive pulmonary embolism or paradoxical embolism. Malignancies are one of the important etiological factors for right heart thrombi. A patient with operated but recurrent ovarian carcinoma, presented with symptoms of heart failure was admitted to oncology department. Rapidly progressing dyspnea and a pre-syncope attack required consultation of a cardiologist and echocardiography revealed a mobile thrombus in the right atrium. Urgent open heart surgery was decided but imminent massive pulmonary embolism complicated the case leading to irreversible cardiogenic shock. By means of the presented case this paper overviews etiological factors and treatment options for right sided heart thrombi.
Management of a huge right atrial thrombus in a patient with multiple comorbidities
The Egyptian Heart Journal
Background Floating right heart thrombi (RHT) represent an underdiagnosed, potentially hazardous, and to some extent rare phenomenon in patients presenting with acute pulmonary embolism (APE). Emergent treatment is usually required for such a condition. Case presentation A 19-year-old young lady presented with progressive shortness of breath, marked renal impairment, thrombocytopenia, and a highly oscillating huge right atrial mass. After she was admitted to the intensive care unit, she arrested in asystole and was resuscitated, and her electrocardiogram (ECG) showed evidence of acute anterior myocardial infarction. Urgent cardiac surgery to remove the right atrial mass was proposed by the heart team as the best option of management. Surgery was emergently performed with extra-corporeal membrane oxygenator (ECMO) as a support. Following surgery, mechanical support and vasopressors were successfully weaned and the patient achieved a good recovery. Conclusions A pulmonary embolism res...