Spontaneous resolution of right ventricular thrombus in congestive heart failure due to alcoholic cardiomyopathy: A case report

Abstract

Right ventricular thrombus (RVT) is rare, and differentiating it from other right ventricular masses is challenging. Additionally, clear guidelines for managing right heart thrombi, particularly type C thrombi, are lacking. A 44-year-old man with congestive heart failure secondary to alcoholic cardiomyopathy was admitted. Echocardiography revealed a highly mobile, elongated mass in the right ventricle, attached to the tendinous cords of the tricuspid valve. Initial treatment for heart failure was administered without anticoagulants. On the 13th day of admission, follow-up echocardiography showed no mass, and pulmonary computed tomography angiography indicated no abnormalities. The patient exhibited no symptoms of pulmonary embolism post-admission. We presumed the mass to be a thrombus, which resolved as the patient's condition improved.

The patient was discharged without anticoagulation therapy. Follow-up echocardiography at 1, 3, and 5 months showed no recurrence of the RVT. We speculated the thrombus to be type C, which unexpectedly resolved as the patient's general condition improved, prior to initiation of anticoagulation therapy.

This case suggests that, in select cases, improvements in hemodynamics and heart function could influence thrombus resolution. However, this finding does not imply that anticoagulation therapy should be initially withheld in similar cases.

Learning objective

Type C right ventricular thrombus (RVT) is rare and its management is not well established. Spontaneous resolution of type C RVT may occur with improved systemic conditions without anticoagulation therapy, suggesting that, in select cases, improvements in hemodynamics and heart function could influence thrombus resolution. However, this finding does not imply that anticoagulation therapy should be initially withheld in similar cases.