Right heart free-floating thrombus in a pregnant woman with massive pulmonary embolism

Massive pulmonary embolism (PE) is a leading cause of maternal death and may require intra-arrest thrombolysis as well as resuscitative hysterotomy. The case presented is a primigravida in her mid-30s at 28 weeks gestation. The patient presented to the emergency department after out-of-hospital cardiac arrest. Return of spontaneous circulation (ROSC) was achieved but not sustained. Episodic cardiopulmonary resuscitation with epinephrine boluses was required. Resuscitative hysterotomy was performed intra-arrest. Echocardiography revealed a dilated right heart consistent with massive PE and thrombolysis was administered. ROSC was obtained thereafter and output was sustained. Subsequent CT brain revealed irreversible hypoxic injury. Treatment was withdrawn with the support of family. Postmortem examination confirmed massive PE. Thrombolysis can restore and improve cardiovascular status in cardiac arrest caused by massive PE. Thrombolysis is not contraindicated in maternal resuscitation where resuscitative hysterotomy may also be required.

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Successful surgical treatment of the patient with right atrial floating thrombus and coronary artery disease on the background of massive pulmonary embolism using hybrid technologies

Kardiologiya i serdechno-sosudistaya khirurgiya ◽

10.17116/kardio20169182-86 ◽

2016 ◽

Vol 9 (1) ◽

pp. 82

Author(s):

A. E. Kandaurov ◽

I. V. Akimov ◽

A. V. Balayan ◽

E. V. Zorin ◽

K. E. Nazaryan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Pulmonary Embolism ◽

Coronary Artery ◽

Surgical Treatment ◽

Massive Pulmonary Embolism ◽

Right Atrial ◽

Floating Thrombus ◽

Hybrid Technologies ◽

Artery Disease

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Free floating thrombus in the right atrium causing massive pulmonary embolism

International Journal of Cardiology ◽

10.1016/j.ijcard.2008.06.014 ◽

2010 ◽

Vol 138 (2) ◽

pp. e21-e23 ◽

Cited By ~ 6

Author(s):

Konstantinos Tsarouhas ◽

Ioannis Kafantaris ◽

Athanasios Antonakopoulos ◽

Georgios Limberopoulos ◽

Ioannis Kouzanidis ◽

...

Keyword(s):

Pulmonary Embolism ◽

Right Atrium ◽

Massive Pulmonary Embolism ◽

Floating Thrombus ◽

The Right

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Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

Case Reports in Emergency Medicine ◽

10.1155/2015/367295 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

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.

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

Prague Medical Report ◽

10.14712/23362936.2020.4 ◽

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.

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