Cardiovasc Imaging Asia.  2021 Jan;5(1):13-15. 10.22468/cvia.2021.00010.

Acute Right Intracardiac Thrombus-in-Transit Complicated by Submassive Pulmonary Embolism

• Shariff RER
• Zaman NB
• Razi AAM
• Khir RN
• Kasim S

• KMID: 2512417
• DOI: http://doi.org/10.22468/cvia.2021.00010

Abstract

A 61-year-old female presented with symptoms suggestive of congestive cardiac failure that was confirmed on transthoracic echocardiography (TTE) with the absence of an intracardiac thrombus. In the hospital, she suffered episodes of syncope, prompting further investigations. Repeat TTE revealed an acute mobile right atrial thrombus, and CT imaging of the pulmonary artery confirmed the presence of a massive pulmonary embolism (PE). Despite a low pulmonary embolism severity index (PESI) score, the patient underwent surgical pulmonary embolectomy. The prevalence of right-sided thrombi ranges between 4–18% in the presence of acute PE, and right-sided thrombi will almost always lead to PE. Our case highlights the limitation of the PESI score and emphasizes urgent management for the presence of a thrombus-in-transit, despite a low PESI score.

Keyword

Pulmonary embolism; Intracardiac thrombus; Case report