Successful treatment of a patient with pulmonary embolism and biatrial thrombus.

Abstract

A 57-year-old male patient was presented to our emergency department with the complaint of dyspnea of 10 days duration. He was normotensive with a heart rate of 82 bpm and normal respiratory rate. Transthoracic echocardiography (TTE) showed right ventricular dilatation with mild tricuspid regurgitation. Pulmonary artery systolic pressure was 50 mmHg. There were mobile masses in both atria (Fig. 1 and Video 1. See corresponding video/movie images at www.anakarder.com). Transesophageal echocardiography (TEE) revealed worm-like, elongated, highly mobile thrombi in right atrium which was extending to the left atrium by crossing the patent foramen ovale (PFO). The free edges of the thrombus were prolapsing towards both the tricuspid and mitral valves to the right and left ventricles, respectively (Fig. 2-4 and Video 2-3. See corresponding video/movie images at www.anakarder.com). Thoracoabdominal computed tomography was performed for evaluation of pulmonary vasculature and if any underlying pathology such as renal cell carcinoma. It showed multiple filling defects of both branches of pulmonary artery. Ultrasound of lower extremity showed absence of thrombus. We had consulted with the cardiovascular surgeons and also discussed the possible complications of treatment modalities with the patient. The patient refused to have an operation so we decided to apply intravenous thrombolytic therapy and it was successfully administered. No thrombi or other cardiac masses were detected on TTE and TEE performed 2 days after thrombolytic treatment and patient had an unevent-