J Cardiovasc Ultrasound.  2013 Mar;21(1):37-39. 10.4250/jcu.2013.21.1.37.

Successful Embolectomy of a Migrated Thrombolytic Free-Floating Massive Thrombus Resulting in a Pulmonary Thromboembolism

• Yoo YP
• Kang KW

• KMID: 1428377
• DOI: http://doi.org/10.4250/jcu.2013.21.1.37

Abstract

The optimal treatment for free-floating massive right heart thrombi remains uncertain. However, they appear to increase the risk of mortality compared to the existence of a solitary pulmonary thromboembolism. Thrombolytic therapy has been shown to be effective in most patients, resulting in complete resolution of the massive thrombus and clinical improvement. We report the echocardiographic disappearance of a free-floating right heart thrombus after thrombolysis, however, the thrombus migrated and resulted in pulmonary thromboembolism. It was successfully removed with surgery.

Keyword

Thrombus; Right heart; Pulmonary embolism; Surgical embolectomy

MeSH Terms

Embolectomy
Heart
Humans
Pulmonary Embolism
Thrombolytic Therapy
Thrombosis

Figure

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  Fig. 1 The initial chest CT showed the free-floating thrombi (arrow) in the right heart (A) and in the pulmonary arteries (B). CT: computed tomography.

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  Fig. 2 The initial echocardiography showed the FFTRH (arrow) (A) and follow-up echocardiography showed resolution of the FFTRH (arrow) (B). FFTRH: free-floating thrombi in the right heart.

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  Fig. 3 No massive FFTRH was found (A) and the FFTRH and fragmented thrombi were extracted from the pulmonary arteries (B). TV (arrow): tricuspid valve, FFTRH: free-floating thrombi in the right heart.

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