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Heart Lung. 2014 Mar-Apr;43(2):152-4. doi: 10.1016/j.hrtlng.2013.08.005. Epub 2013 Sep 14.

Large embolus in transit - an unresolved therapeutic dilemma (case report and review of literature).

Author information

1
Department of Medicine, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY 10305, USA. Electronic address: vratika.agarwal@gmail.com.
2
Department of Medicine, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY 10305, USA.
3
Department of Cardiothoracic Research, Staten Island University Hospital, Staten Island, NY, USA.
4
Department of Cardiology, Staten Island University Hospital, Staten Island, NY, USA.
5
Department of Critical Care Medicine, Staten Island University Hospital, Staten Island, NY, USA.
6
Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA.

Abstract

Floating right heart thrombus, also known as "emboli in transit" is a potentially fatal condition, of varying etiology and usually coexisting with massive pulmonary embolism. Although the mortality rate is as high as 40%, there are no established therapeutic guidelines. A case is presented of an 84 year old female with a history of colon cancer and coronary artery disease who presented with sudden onset unresponsiveness. She was intubated in the ED and started on intravenous pressor support. A free floating large right ventricular thrombus and dilated right ventricle were noted on transthoracic echocardiogram (TTE). She was managed medically with good short term outcome. Floating right heart thrombus is a rare occurrence. Recognition of signs and symptoms along with early TTE is critical for diagnosis and consideration of treatment modality. The existing literature does not offer a clear consensus for management of pulmonary embolism with co-existing mobile intra-cardiac thrombus. Choice of treatment is crucial and should be considered on a case-by-case basis after careful assessment of indications, contraindications, risks and benefits.

KEYWORDS:

Critical care; Right heart thrombus; Thrombolytic therapy; Transthoracic echocardiography

PMID:
24041566
DOI:
10.1016/j.hrtlng.2013.08.005
[Indexed for MEDLINE]
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