scholarly journals Acute Massive Pulmonary Embolism with Direct Visualization of a Free-floating Right Heart Thrombus Successfully Treated with Fibrinolysis: A Case Report

2020 ◽  
Vol 121 (1) ◽  
pp. 42-48
Author(s):  
Elisavet Kaitalidou ◽  
Dimitrios Karapiperis ◽  
Vasileios Makrakis ◽  
Maria Kipourou ◽  
Dimitrios Petroglou
Keyword(s):  
Pulmonary Embolism ◽  
Hemodynamic Instability ◽  
Massive Pulmonary Embolism ◽  
Right Atrial ◽  
Direct Visualization ◽  
Atrial Thrombus ◽  
Right Heart ◽  
Motor Weakness ◽  
History Of ◽  
The Right

A male patient with a history of immobilization due to motor weakness, was transferred to our emergency department after syncope during physiotherapy, with recorded hypotension. Transthoracic echocardiography showed severe dilatation of the right ventricle (RV), with apex hypercontractility and almost akinetic RV free wall. The above findings, in addition to the unexpected visualization of a large, free-floating, right atrial thrombus, a rare finding associated with high mortality, readily confirmed the clinical suspicion of acute pulmonary embolism (PE) causing circulatory collapse. Intravenous fibrinolysis and vasopressor therapy were successfully administered, and hemodynamic instability was soon alleviated.

scholarly journals Management of a huge right atrial thrombus in a patient with multiple comorbidities

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Peter Philip Shaker Selwanos ◽  
Ahmed Osman Ahmed ◽  
Karim Mohamed El Bakry ◽  
Ahmed Nazmy Elsharkawy ◽  
Omar Alaaeldin Mohamed ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Right Atrial ◽  
Heart Team ◽  
Anterior Myocardial Infarction ◽  
Right Heart ◽  
Atrial Mass ◽  
Response Team ◽  
Right Atrial Mass ◽  
The Right

Abstract 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 response team (PERT) approach should always be considered where a multidisciplinary team involving a cardiologist, radiologist, cardio-thoracic surgeon, radiologist, and intensivist shall determine the management strategy for a challenging presentation of a massive pulmonary embolism or floating right heart thrombi causing the hemodynamically unstable clinical condition.

The Right Atrial Thrombus: The Sword of Damocles With Real Risk of Massive Pulmonary Embolism

Angiology ◽  
2008 ◽  
Vol 59 (4) ◽  
pp. 415-420 ◽  
Author(s):  
Marijan Kirin ◽  
Reuf Cerić ◽  
Marko Špoljarić ◽  
Mario Pehar ◽  
Gordana Cavrić ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
Real Risk ◽  
Right Atrial Thrombus ◽  
The Right

Ultrasound-assisted lysis using recombinant tissue plasminogen activator and the EKOS EkoSonic endovascular system for treating right atrial thrombus and massive pulmonary embolism: A case study

2014 ◽  
Vol 30 (10) ◽  
pp. 739-743 ◽  
Author(s):  
NW Shammas ◽  
R Padaria ◽  
G Ahuja
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Plasminogen Activator ◽  
Pulmonary Embolus ◽  
Massive Pulmonary Embolism ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
Tissue Plasminogen ◽  
Ultrasound System ◽  
Right Atrial Thrombus

Objective Right atrial thrombus in the setting of a large pulmonary embolus is rare and is associated with serious adverse events. This case report presents the role played by EKOS EkoSonic ultrasound system in successfully treating right atrial thrombus and massive pulmonary embolism. Case report A 69-year-old female presented with a massive pulmonary embolus and a large mobile right atrial thrombus. She was treated with catheter-directed lysis using the EKOS EkoSonic ultrasound system and tissue plasminogen activator, with complete resolution of her right atrial thrombus and a marked improvement in her pulmonary embolus and hemodynamics. Conclusion This case report provides a new and an effective option to treat right atrial thrombus associated with a large pulmonary embolus leading to a good outcome.

scholarly journals Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Gerard O’Connor ◽  
Gareth Fitzpatrick ◽  
Ayman El-Gammal ◽  
Peadar Gilligan
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Recombinant Tissue Plasminogen Activator ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Right Heart ◽  
Tissue Plasminogen ◽  
End Tidal ◽  
The Right ◽  
High Level

More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient’s cardiac arrest, the extremely low end-tidal CO2suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect.

scholarly journals P1702 Libman-Sacks endocarditis of the mitral valve combined with right atrial thrombus formation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Klappacher ◽  
D Beitzke
Keyword(s):  
Mitral Valve ◽  
Thrombus Formation ◽  
Arterial System ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
Systemic Embolization ◽  
History Of ◽  
Right Atrial Thrombus ◽  
The Right ◽  
The Brain

Abstract Case presentation A 46-years old female with a history of systemic lupus erythematosus (SLE) was admitted to hospital care after the manifestation of a tonic-clonic generalized seizure. Since this had been the first neurological event, a thorough diagnostic work-up was performed. CT- and MRI-imaging of the brain revealed cerebral microangiopathy and two small fresh ischemic lesions in the left frontal and temporobasal regions, respectively. While the microangiopathy could be reconciled with cerebral SLE-vasculitis, the ischemic lesions pointed to thromboembolism whose source could be potentially cardiogenic. Findings. In fact, the transesophageal echocardiogram showed a small vegetation (5x8 mm) on the posteromedial cusp of the posterior mitral leaflet (P3) with moderate regurgitation, likely to represent Libman-Sacks endocarditis and a potential source of systemic embolization. In addition, a mass of was visible protruding from the fossa ovalis into the right atrium, see figure. It represented a thrombus according to MRI which was subsequently performed. Since no interatrial passage of microbubbles occurred, the foramen ovale was unlikely to be patent and to allow for paradoxical embolism into the brain. However, the right atrial thrombus was compatible with a history of repeated deep venous thrombosis and pulmonary embolism in the recent past. Discussion This case exemplifies the combination of Libman-Sacks endocarditis on the mitral valve with right atrial thrombus formation and ensuing embolism both into the venous and arterial system. It demonstrates the importance of closely monitoring and treating coagulopathies in SLE patients which makes them prone to thrombus formation both in the systemic and pulmonary circulation. Abstract P1702 Figure.

Iatrogenic Right Atrial Thrombus Complicated by Pulmonary Embolism: Management and Outcomes

2020 ◽  
Vol 16 ◽  
Author(s):  
Ayman Battisha ◽  
Bader Madoukh ◽  
Khalid Sawalha
Keyword(s):  
Pulmonary Embolism ◽  
Vascular Occlusion ◽  
Central Venous Catheters ◽  
Right Atrial ◽  
Central Venous ◽  
Atrial Thrombus ◽  
True Incidence ◽  
Asymptomatic Patients ◽  
Right Atrial Thrombus ◽  
The Right

Abstract:: Right atrial thrombus can originate from distal venous sources or can be iatrogenic secondary to placement of central venous catheters, atrial devices, or surgeries. One of the most common complications of central venous catheters (CVCs) is thromboembolism, which can be either fixed to the right atrium or can be free-floating. Device-related right atrial thrombosis (RAT) can result in catheter occlusion, vascular occlusion, infection, and pulmonary embolism. The true incidence of these complications is unknown because the diagnosis may not be considered in asymptomatic patients and might be missed by transthoracic echocardiography (TTE). In this literature review, we discuss iatrogenic etiologies of RAT that is complicated by pulmonary embolism. We highlight the importance of maintaining a high index of suspicion of iatrogenic RAT, possible complications, and its management.

scholarly journals Clot in Lung, Clot in Heart: A Case Report of Tumor-Like Thrombus in Right Atrium

2017 ◽  
Vol 10 ◽  
pp. 117954761769846 ◽  
Author(s):  
Roshanak Habibi ◽  
Alvaro J Altamirano ◽  
Shahriar Dadkhah
Keyword(s):  
Clinical Judgment ◽  
Right Atrium ◽  
Pulmonary Thromboembolism ◽  
Incidental Finding ◽  
Atrial Septum ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
Right Heart ◽  
Right Atrial Thrombus ◽  
The Right

Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung. The challenging management was to resect this thrombus which was fixed to atrial septum, and a trial of anticoagulation did not resolve it. Exact management of such incidental findings in right heart cavities is not well established. Some cases may benefit from resection of such formed fixed thrombus.

scholarly journals Catheter-Related Right Atrial Thrombus and Pulmonary Embolism: A Case Report and Systematic Review of the Literature

2009 ◽  
Vol 16 (5) ◽  
pp. 163-165 ◽  
Author(s):  
Karen EA Burns ◽  
Andrew McLaren
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Right Atrial ◽  
Pulmonary Vasculature ◽  
Review Of The Literature ◽  
Atrial Thrombus ◽  
Right Heart ◽  
True Incidence ◽  
Increased Risk ◽  
Right Atrial Thrombus

Central venous catheters (CVCs) are commonly used in clinical practice. One of the foremost complications associated with their use is the potential for symptomatic or asymptomatic thrombosis. CVC thrombosis, in turn, may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Thrombi within cardiac chambers are associated with an increased risk of mortality due to their potential for embolization to the pulmonary vasculature. We describe the case of a 77-year-old man, who was successfully thrombolyzed following detection of a right atrial thrombus and hemodynamically significant pulmonary embolism resulting from thrombus formation on the tip of a peripherally inserted central catheter (PICC). The present article is the first report of a PICC-related right atrial thrombus in an adult treated with thrombolysis. A systematic review of the literature suggests that the true incidence of this complication may be underestimated because the diagnosis may not be considered in asymptomatic and symptomatic patients, or may be missed by transthoracic echocardiography. The present case highlights the importance of maintaining a high index of suspicion for thromboembolic complications and heparin-induced thrombocytopenia in patients with CVCs or a PICC. It also underscores the important role of transesophageal echocardiography and thrombolysis in the diagnosis and management, respectively, of right heart thromboemboli with associated pulmonary embolism.

scholarly journals Traveling Thrombus in the Right Atrium: Is It the Final Destination?

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Maneesh Bhargava ◽  
Erhan Dincer
Keyword(s):  
Right Atrium ◽  
Right Atrial ◽  
Shortness Of Breath ◽  
Normal Heart ◽  
Atrial Thrombus ◽  
Right Heart ◽  
Final Destination ◽  
Right Atrial Thrombus ◽  
The Right

Right heart thrombus is rare in structurally normal heart. Here, we report a 74-year-old man with a right atrial thrombus who presented with shortness of breath.

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