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First published on April 2, 2008
Angiology 2008, doi:10.1177/0003319707306218
© 2008 SAGE Publications

Article

The Right Atrial Thrombus: The Sword of Damocles With Real Risk of Massive Pulmonary Embolism

Marijan Kirin, PhD*, Reuf Ceric, MD, Marko Spoljaric, MD, Mario Pehar, MD, Gordana Cavric, MD, Ivana Rajcan Spoljaric, MD, and Ivan Kirin, MD

Clinical Hospital Dubrava

* To whom correspondence should be addressed. E-mail: mkirin{at}kbd.hr.


  Abstract
Cases of 6 patients admitted at the intensive care unit for massive pulmonary embolism are reported. All patients presented with dyspnea, tachypnea, and tachycardia, and 4 were hypotensive and had syncope. Lung ventilation/perfusion scans revealed perfusion defects in 4 patients. Transthoracic echocardiography (TTE) demonstrated acute cor pulmonale. It also revealed mobile right atrial thrombi in 5 patients, adherent thrombus in the right atrium in 1 patient and patent foramen ovale in 4 patients. Thrombolytic therapy was initiated in 4 patients, and 2 patients received heparin infusion only. Effects of thrombolysis were monitored using bedside TTE during the first 24 hours and in follow-up. The outcome of 4 patients who received thrombolytic therapy was good whereas other 2 patients, who received only heparin, died. Thrombotic mass disappeared 8 to 12 hours after initiation of therapy, and 10 weeks after discharge TTE showed normalized right ventricle dimensions and function in all 4 patients.


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